Healthcare Provider Details

I. General information

NPI: 1215847306
Provider Name (Legal Business Name): LASONIA MARIE BURKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 S REDWOOD RD
SLC UT
84104-5112
US

IV. Provider business mailing address

1875 S REDWOOD RD
SLC UT
84104-5112
US

V. Phone/Fax

Practice location:
  • Phone: 801-355-2846
  • Fax: 801-359-3244
Mailing address:
  • Phone: 801-355-2846
  • Fax: 801-359-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: