Provider Demographics
NPI:1548706955
Name:OSSMEN, CAITLIN (RBT, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:OSSMEN
Suffix:
Gender:F
Credentials:RBT, BCBA, LBA
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:PAIGE
Other - Last Name:BALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 S 700 E STE 2A
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2855
Mailing Address - Country:US
Mailing Address - Phone:801-935-4171
Mailing Address - Fax:888-261-6694
Practice Address - Street 1:515 S 700 E STE 2A
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84102-2855
Practice Address - Country:US
Practice Address - Phone:801-935-4171
Practice Address - Fax:888-261-6694
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT103K00000X
106S00000X
UT11000974-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician