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General NPI Number Information
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NPI Number | 1083139497
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Entity Type | Individual
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Provider Name | MR. MITCH SMEDING WANGSGARD
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Gender | Male
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Dates
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Enumeration Date | 08/07/2017
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 2121 N 1700 W
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City | LAYTON
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State | UT
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Zip | 84041-8803
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Country | US
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Telephone | 801-773-4840
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Fax | 801-525-8151
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Provider Business Mailing Address
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Address Line | PO BOX 337
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City | LAYTON
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State | UT
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Zip | 84041-0337
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Country | US
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Telephone | 18-773-4840
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Fax | 801-525-8151
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2017025273
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 11356974-4101
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License Number State | UT
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