Provider Demographics
NPI:1275172363
Name:WASATCH LEARNING & DEVELOPMENT
Entity Type:Organization
Organization Name:WASATCH LEARNING & DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMOOT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:385-645-4947
Mailing Address - Street 1:8170 S HIGHLAND DR STE E5
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6469
Mailing Address - Country:US
Mailing Address - Phone:385-645-4947
Mailing Address - Fax:
Practice Address - Street 1:8170 S HIGHLAND DR STE E5
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6469
Practice Address - Country:US
Practice Address - Phone:385-645-4947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty