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NPI Code Detail

MEDICARE: EVAN SMITH

MEDICARE: EVAN SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1417895640
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVAN SMITH
Provider Business Mailing Address
First Line : 1443 W 800 N STE 103
Second Line :
City : OREM
State : UT
Zip : 84057-2878
Country : US
Telephone Number : 801-655-4950
Fax Number :
Provider Business Practice Location Address
First Line : 545 W 465 N STE 100
Second Line :
City : PROVIDENCE
State : UT
Zip : 84332-8004
Country : US
Telephone Number : 801-655-4950
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2026
Last Update Date : 03/21/2026

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Directions to “ EVAN SMITH ” Practice Location

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