Healthcare Provider Details

I. General information

NPI: 1013846633
Provider Name (Legal Business Name): LZ CRIDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 12TH ST
OGDEN UT
84404-5712
US

IV. Provider business mailing address

2252 N 300 W
HARRISVILLE UT
84414-7353
US

V. Phone/Fax

Practice location:
  • Phone: 808-462-9897
  • Fax:
Mailing address:
  • Phone: 808-462-9897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1428056-2506
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: