Healthcare Provider Details

I. General information

NPI: 1689319345
Provider Name (Legal Business Name): LEXI TODD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 ANTELOPE DR UNIT E
SYRACUSE UT
84075-1204
US

IV. Provider business mailing address

938 UNIVERSITY PARK BLVD
CLEARFIELD UT
84015-6283
US

V. Phone/Fax

Practice location:
  • Phone: 801-989-3488
  • Fax:
Mailing address:
  • Phone: 801-928-7173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13400954-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: