MEDICARE: MRS. LAUREN LACAYO DE RODAS

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	106S00000X	Behavior Technician		UT

General Provider Information

NPI Number	:	1972475572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN LACAYO DE RODAS

Provider Business Mailing Address
First Line	:	8629 S 1240 E
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84094-1969
Country	:	US
Telephone Number	:	801-800-1114
Fax Number	:

Provider Business Practice Location Address
First Line	:	8629 S 1240 E
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84094-1969
Country	:	US
Telephone Number	:	801-800-1114
Fax Number	:

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

Provider Enumeration Date	:	09/22/2025
Last Update Date	:	09/22/2025

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