Healthcare Provider Details

I. General information

NPI: 1295543965
Provider Name (Legal Business Name): ZAYAH M COOK
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5307 S KNOLLCREST ST APT A
MURRAY UT
84107-6320
US

IV. Provider business mailing address

2025 S 50 W
BOUNTIFUL UT
84010-5559
US

V. Phone/Fax

Practice location:
  • Phone: 208-901-4615
  • Fax:
Mailing address:
  • Phone: 801-548-3091
  • Fax: 801-992-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: