MEDICARE: KRYSTAL DAGLEY

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
1	106H00000X	Marriage & Family Therapist	8199455-3902	UT

General Provider Information

NPI Number	:	1427590686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL DAGLEY

Provider Business Mailing Address
First Line	:	11038 HIGHLAND BLVD STE 300
Second Line	:
City	:	HIGHLAND
State	:	UT
Zip	:	84003-3788
Country	:	US
Telephone Number	:	801-899-9041
Fax Number	:	320-204-6481

Provider Business Practice Location Address
First Line	:	11038 HIGHLAND BLVD STE 300
Second Line	:
City	:	HIGHLAND
State	:	UT
Zip	:	84003-3788
Country	:	US
Telephone Number	:	801-899-9041
Fax Number	:	320-204-6481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2016
Last Update Date	:	04/13/2018

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Directions to “ KRYSTAL DAGLEY ” Practice Location

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