Healthcare Provider Details

I. General information

NPI: 1295348845
Provider Name (Legal Business Name): MRS. MEGAN RENAE SMART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN RELF

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7885 S 700 E
SANDY UT
84070-0257
US

IV. Provider business mailing address

7885 S 700 E
SANDY UT
84070-0257
US

V. Phone/Fax

Practice location:
  • Phone: 801-895-9687
  • Fax:
Mailing address:
  • Phone: 801-895-9687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128651763501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: