Provider Demographics
NPI:1033796420
Name:FALLON, EVA ALEXANDRIA (ABA)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:ALEXANDRIA
Last Name:FALLON
Suffix:
Gender:F
Credentials:ABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 W 280 N
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9119
Mailing Address - Country:US
Mailing Address - Phone:435-554-4087
Mailing Address - Fax:
Practice Address - Street 1:338 W 300 N
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:UT
Practice Address - Zip Code:84318-4044
Practice Address - Country:US
Practice Address - Phone:801-382-9338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst