MEDICARE: TRACI SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1245995943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI SMITH

Provider Business Mailing Address
First Line	:	515 S 700 E STE 2A
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2855
Country	:	US
Telephone Number	:	801-935-4171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 W 1130 S BUILDING B
Second Line	:
City	:	OREM
State	:	UT
Zip	:	84102-8410
Country	:	US
Telephone Number	:	801-935-4171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2021
Last Update Date	:	11/08/2021

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Directions to “ TRACI SMITH ” Practice Location

Language	Start Address	Practice Location

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