Healthcare Provider Details

I. General information

NPI: 1114735347
Provider Name (Legal Business Name): ADDISON TAYLOR LESZYNSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E 4500 S UNIT A
SALT LAKE CITY UT
84107-2712
US

IV. Provider business mailing address

5226 S LUCKY CLOVER LN
MURRAY UT
84123-8455
US

V. Phone/Fax

Practice location:
  • Phone: 801-771-0273
  • Fax:
Mailing address:
  • Phone: 801-603-0682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1252809
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: