Healthcare Provider Details

I. General information

NPI: 1215418504
Provider Name (Legal Business Name): MEGHAN ALEXANDRA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 N HILL FIELD RD STE 3
LAYTON UT
84041-5056
US

IV. Provider business mailing address

415 MEDICAL DR STE B102
BOUNTIFUL UT
84010-4989
US

V. Phone/Fax

Practice location:
  • Phone: 385-275-0492
  • Fax:
Mailing address:
  • Phone: 385-275-0492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12353583-4104
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: