Healthcare Provider Details

I. General information

NPI: 1316760614
Provider Name (Legal Business Name): MEKELL SMITH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 N WELDEN WAY
LAYTON UT
84041-8874
US

IV. Provider business mailing address

351 N WELDEN WAY
LAYTON UT
84041-8874
US

V. Phone/Fax

Practice location:
  • Phone: 385-321-4714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MEKELL SMITH
Title or Position: OWNER
Credential: MS CCC-SLP
Phone: 385-321-4714