Healthcare Provider Details

I. General information

NPI: 1518343169
Provider Name (Legal Business Name): MICHELLE STAGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE STEPHENS

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 S GENEVA RD
OREM UT
84058
US

IV. Provider business mailing address

1875 S GENEVA RD
OREM UT
84058-2217
US

V. Phone/Fax

Practice location:
  • Phone: 801-437-0490
  • Fax:
Mailing address:
  • Phone: 801-437-0490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11690675-2506
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: