Healthcare Provider Details

I. General information

NPI: 1427706423
Provider Name (Legal Business Name): TONYA ALICE SMITH CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W 7200 S STE 104
MIDVALE UT
84047-1014
US

IV. Provider business mailing address

251 N CORNELL ST UNIT 213
SLC UT
84116-3992
US

V. Phone/Fax

Practice location:
  • Phone: 385-404-4296
  • Fax:
Mailing address:
  • Phone: 801-688-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: