Individual
MICAH SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6033 FASHION POINT DR, SOUTH OGDEN, UT 84403-4847
(605) 271-2690
Mailing address
3697 OAKRIDGE DR, BOUNTIFUL, UT 84010-5864
(928) 388-8494
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
12254646-2506
UT
106S00000X
Behavior Technician
—
—
Other
Enumeration date
07/06/2018
Last updated
06/21/2023
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