Healthcare Provider Details

I. General information

NPI: 1841157591
Provider Name (Legal Business Name): TEANNA PARKER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 S 800 W SUITE 210
DRAPER UT
84020
US

IV. Provider business mailing address

919 CALLIE CT
NORTH SALT LAKE UT
84054-0165
US

V. Phone/Fax

Practice location:
  • Phone: 801-923-3537
  • Fax:
Mailing address:
  • Phone: 801-923-3537
  • Fax: 801-753-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: