Healthcare Provider Details

I. General information

NPI: 1528984572
Provider Name (Legal Business Name): NATANE ANASTASIA GRIFFITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 E COTTONWOOD PKWY STE 500
SALT LAKE CITY UT
84121-7060
US

IV. Provider business mailing address

1317 W PHARAOH RD
SALT LAKE CITY UT
84123-1235
US

V. Phone/Fax

Practice location:
  • Phone: 385-442-5895
  • Fax:
Mailing address:
  • Phone: 603-832-3139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberNHL17334190
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: