Healthcare Provider Details

I. General information

NPI: 1992279913
Provider Name (Legal Business Name): MEGAN DAVIS SMITH BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN DAVIS RBT

II. Dates (important events)

Enumeration Date: 01/12/2019
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5974 FASHION POINT DR
SOUTH OGDEN UT
84403-4699
US

IV. Provider business mailing address

613 COOK DR
LAYTON UT
84041-3005
US

V. Phone/Fax

Practice location:
  • Phone: 801-683-1062
  • Fax:
Mailing address:
  • Phone: 385-777-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number123821802506
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-53282
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: