MEDICARE: ROBERT SMITH LASUDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	12275216-6008	UT

General Provider Information

NPI Number	:	1811862857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT SMITH LASUDC

Provider Business Mailing Address
First Line	:	10696 S OZARKS DR
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-5717
Country	:	US
Telephone Number	:	801-647-5523
Fax Number	:

Provider Business Practice Location Address
First Line	:	9130 S STATE ST STE 210
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-2681
Country	:	US
Telephone Number	:	801-998-2116
Fax Number	:

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

Provider Enumeration Date	:	10/08/2025
Last Update Date	:	10/08/2025

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