Healthcare Provider Details

I. General information

NPI: 1134039696
Provider Name (Legal Business Name): DYLAN ROLLAND TINGEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N 870 W STE 101-104
LOGAN UT
84321-6899
US

IV. Provider business mailing address

650 N 870 W STE 101-104
LOGAN UT
84321-6899
US

V. Phone/Fax

Practice location:
  • Phone: 888-392-8642
  • Fax:
Mailing address:
  • Phone: 888-392-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number229472592
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: