Healthcare Provider Details

I. General information

NPI: 1699323550
Provider Name (Legal Business Name): SCOTT EYRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 S OREM BLVD STE 1
OREM UT
84058-5030
US

IV. Provider business mailing address

927 S 890 W
PROVO UT
84601-4563
US

V. Phone/Fax

Practice location:
  • Phone: 801-802-8608
  • Fax: 801-221-1042
Mailing address:
  • Phone: 801-669-4969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: