Healthcare Provider Details

I. General information

NPI: 1487013975
Provider Name (Legal Business Name): MICHELLE HANNAH JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE HANNAH RECHIS

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 N CHURCH ST STE 204
LAYTON UT
84040-6616
US

IV. Provider business mailing address

6013 S REDWOOD RD
TAYLORSVILLE UT
84123-5220
US

V. Phone/Fax

Practice location:
  • Phone: 801-614-2587
  • Fax: 801-255-5131
Mailing address:
  • Phone: 801-255-5131
  • Fax: 801-255-5131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: