Healthcare Provider Details

I. General information

NPI: 1992028658
Provider Name (Legal Business Name): EMILY LOTT SMITH MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 COTTONWOOD ST
MURRAY UT
84107-5701
US

IV. Provider business mailing address

2932 DESERT FOREST LN
LEHI UT
84043-6520
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-1247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7369580-4102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: