Gordon John Waller, is a
Behavior Technician based in Orem, Utah. Gordon John Waller is licensed to practice in * (Not Available) (license number ) and his current practice location is
475 W 260 N, Orem, Utah. He can be reached at his office (for appointments etc.) via phone at
(801) 221-9930.
NPI number for Gordon John Waller is 1780121731 and his current mailing address is 475 W 260 N, Orem, Utah. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1780121731.
Healthcare Provider's Profile
| Full Name | Gordon John Waller |
|---|
| Gender | Male |
|---|
| Speciality | Behavior Technician |
|---|
| Location | 475 W 260 N, Orem, Utah |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1780121731
- Provider Enumeration Date: 01/30/2017
- Last Update Date: 01/12/2021
Medical Identifiers
Medical identifiers for Gordon John Waller such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1780121731 | NPI | - | NPPES |
| 1396085718 | Medicaid | UT | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 106S00000X | Behavior Technician | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Gordon John Waller is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Gordon John Waller,
475 W 260 N,
Orem, UT 84057-1970
Ph: () - | Gordon John Waller,
475 W 260 N,
Orem, UT 84057-1970
Ph: (801) 221-9930 |
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