Healthcare Provider Details

I. General information

NPI: 1184316291
Provider Name (Legal Business Name): EMILY BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5242 S COLLEGE DR STE 380
MURRAY UT
84123-2753
US

IV. Provider business mailing address

723 EAGLE WAY
FRUIT HEIGHTS UT
84037-3218
US

V. Phone/Fax

Practice location:
  • Phone: 877-264-6747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number14305124-2506
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: