Healthcare Provider Details

I. General information

NPI: 1598471641
Provider Name (Legal Business Name): MADISON TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 S STATE ST
CLEARFIELD UT
84015-1793
US

IV. Provider business mailing address

12222 S 1000 E STE 3
DRAPER UT
84020-3203
US

V. Phone/Fax

Practice location:
  • Phone: 385-390-0027
  • Fax:
Mailing address:
  • Phone: 801-987-3592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number14275547-2507
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: