MEDICARE: ALEXIS GRANT

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	172V00000X	Community Health Worker
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1710830245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS GRANT

Provider Business Mailing Address
First Line	:	1970 W 7800 S
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-4025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1970 W 7800 S
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-4025
Country	:	US
Telephone Number	:	801-506-6695
Fax Number	:

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

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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Directions to “ ALEXIS GRANT ” Practice Location

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