Provider Demographics
NPI:1720612427
Name:SMITH, DIANA (BCBA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:SEADE-DURAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:253 W DELGADA LN
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-4034
Mailing Address - Country:US
Mailing Address - Phone:703-994-3790
Mailing Address - Fax:
Practice Address - Street 1:1441 E FT UNION BLVD
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-2847
Practice Address - Country:US
Practice Address - Phone:385-695-2203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst