Active NPI
Holly Ryan Peterson
- Behavior Technician
- Tooele, UT
National Provider Identifier
1699547422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 272 N Broadway St Ste 101
Tooele, UT 84074-2244 - Phone
- (801) 771-0273
- Fax
- (801) 771-0221
- NPI assigned
- Oct 25, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
272 N Broadway St Ste 101
Tooele, UT 84074-2244
Mailing address
272 N Broadway St Ste 101
Tooele, UT 84074-2244
Phone (801) 771-0273
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698192000000",
"number": "1699547422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "272 N BROADWAY ST STE 101",
"city": "TOOELE",
"state": "UT",
"postal_code": "840742244",
"telephone_number": "801-771-0273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "272 N BROADWAY ST STE 101",
"city": "TOOELE",
"state": "UT",
"postal_code": "840742244",
"telephone_number": "801-771-0273",
"fax_number": "801-771-0221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "HOLLY",
"middle_name": "RYAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-10-25",
"last_updated": "2023-10-25",
"certification_date": "2023-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tooele, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.