MEDICARE: PAMELA KENNA GODETTE-MILLER

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1972186914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA KENNA GODETTE-MILLER

Provider Business Mailing Address
First Line	:	663 E AUBURN FIELDS WAY
Second Line	:
City	:	DRAPER
State	:	UT
Zip	:	84020-6600
Country	:	US
Telephone Number	:	801-979-6146
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 E WASATCH POINT LN APT 27201
Second Line	:
City	:	DRAPER
State	:	UT
Zip	:	84020-8035
Country	:	US
Telephone Number	:	801-979-6146
Fax Number	:

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

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	12/03/2024

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