MEDICARE: TONYA ALICE SMITH CCM

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	171M00000X	Case Manager/Care Coordinator		UT

General Provider Information

NPI Number	:	1427706423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA ALICE SMITH CCM

Provider Business Mailing Address
First Line	:	251 N CORNELL ST UNIT 213
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84116-3992
Country	:	US
Telephone Number	:	801-688-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 W 7200 S STE 104
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-1014
Country	:	US
Telephone Number	:	385-404-4296
Fax Number	:

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

Provider Enumeration Date	:	03/17/2022
Last Update Date	:	05/13/2026

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