Healthcare Provider Details

I. General information

NPI: 1588024905
Provider Name (Legal Business Name): MELISSA ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6558 S STANWICK RD APT 31
COTTONWOOD HEIGHTS UT
84121-2694
US

IV. Provider business mailing address

10307 S EDGECLIFF DR
SANDY UT
84092-4355
US

V. Phone/Fax

Practice location:
  • Phone: 805-990-4718
  • Fax:
Mailing address:
  • Phone: 805-990-4718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number10654593-2506
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: