MEDICARE: WASATCH LEARNING & DEVELOPMENT

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1275172363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASATCH LEARNING & DEVELOPMENT

Provider Business Mailing Address
First Line	:	8170 S HIGHLAND DR STE E5
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-6469
Country	:	US
Telephone Number	:	385-645-4947
Fax Number	:

Provider Business Practice Location Address
First Line	:	8170 S HIGHLAND DR STE E5
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-6469
Country	:	US
Telephone Number	:	385-645-4947
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRACINE SMOOT
Credential	:	PH.D.
Telephone Number	:	385-645-4947

Provider Enumeration Date	:	01/06/2020
Last Update Date	:	01/06/2020

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Directions to “WASATCH LEARNING & DEVELOPMENT ” Practice Location

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