| Provider / Organization | NPI | Date Certified |
|---|---|---|
| AUDREY TETRYANA HERU HENDARTO | 1518604248 | 2022-05-15 |
Audrey Tetryana Heru Hendarto is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1518604248. Registration indicates Audrey Tetryana Heru Hendarto is a provider of services with a specialization in Behavioral Health & Social Service Providers, Behavior Technician (Behavior Technician, Behavioral Health & Social Service Providers) (Behavior Technician, )
| Entity Type | Individual |
| Provider Name | Audrey Tetryana Heru Hendarto |
| Practice Office Address | 344 E 100 S STE 301 SLC, UT US |
| Practice Office Telephone | 8014284257 |
| Mailing Address | 344 E 100 S STE 301 SLC, UT 841111727 US |
| Code | Practice | License No State |
|---|---|---|
| 106S00000X PRIMARY | Behavioral Health & Social Service Providers Behavior Technician Behavior Technician Behavioral Health & Social Service Providers Behavior Technician |