Provider Demographics
NPI:1831786417
Name:DRAGO, MIKAYLA RAY
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:RAY
Last Name:DRAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:RAY
Other - Last Name:LEBOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3950 W 4100 S
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-8815
Mailing Address - Country:US
Mailing Address - Phone:385-446-0733
Mailing Address - Fax:
Practice Address - Street 1:3950 W 4100 S
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-8815
Practice Address - Country:US
Practice Address - Phone:385-446-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14197740-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst