Individual
KODY LEO DALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1175 E 300 N, PROVO, UT 84606
(801) 852-4510
Mailing address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
1955
UT
Other
Enumeration date
07/24/2025
Last updated
07/24/2025
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