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NPI Code Detail

MEDICARE: BRADY GAGON

MEDICARE: BRADY GAGON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1780435693
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADY GAGON
Provider Business Mailing Address
First Line : 10298 S OTTER TRAIL DR
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84009-6109
Country : US
Telephone Number : 801-317-7996
Fax Number :
Provider Business Practice Location Address
First Line : 10298 S OTTER TRAIL DR
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84009-6109
Country : US
Telephone Number : 801-317-7996
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2024
Last Update Date : 03/28/2024

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Directions to “ BRADY GAGON ” Practice Location

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