Provider Demographics
NPI:1831822485
Name:PURCELL-DEMOSS, ROANNE (RBT)
Entity type:Individual
Prefix:
First Name:ROANNE
Middle Name:
Last Name:PURCELL-DEMOSS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 E BELSAW CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5437
Mailing Address - Country:US
Mailing Address - Phone:801-319-3997
Mailing Address - Fax:
Practice Address - Street 1:8031 S. 700 W.
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070
Practice Address - Country:US
Practice Address - Phone:385-695-2203
Practice Address - Fax:435-292-7068
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTRBT-21-187985106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician