MEDICARE: SARAH JANE MCCONKIE

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1780316364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH JANE MCCONKIE

Provider Business Mailing Address
First Line	:	1240 E STRINGHAM AVE RM 2
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2560
Country	:	US
Telephone Number	:	801-214-1115
Fax Number	:	801-340-2115

Provider Business Practice Location Address
First Line	:	1240 E STRINGHAM AVE RM 2
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2560
Country	:	US
Telephone Number	:	801-214-1115
Fax Number	:

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

Provider Enumeration Date	:	06/30/2022
Last Update Date	:	02/25/2026

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