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NPI Code Detail

MEDICARE: MARY E MATTINGLY

MEDICARE: MARY E MATTINGLY
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
1103K00000XBehavior Analyst11555349-2506UT

General Provider Information

NPI Number : 1881118784
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY E MATTINGLY
Provider Business Mailing Address
First Line : 6910 S HIGHLAND DR STE 1
Second Line :
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84121-3061
Country : US
Telephone Number : 801-935-4171
Fax Number : 801-935-4946
Provider Business Practice Location Address
First Line : 6910 S HIGHLAND DR STE 1
Second Line :
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84121-3061
Country : US
Telephone Number : 801-935-4171
Fax Number : 801-935-4946
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2017
Last Update Date : 01/01/2020

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Directions to “ MARY E MATTINGLY ” Practice Location

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