Individual
MEGAN E BLACK-SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP, M.S, CCC
Contact information
Practice address
1325 E BROWNING AVE, SALT LAKE CITY, UT 84105-2601
(480) 204-1353
Mailing address
1325 E BROWNING AVE, SALT LAKE CITY, UT 84105-2601
(480) 204-1353
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
2355S0801X
Speech-Language Assistant
SLPA7196
AZ
235Z00000X
Speech-Language Pathologist
Primary
12104020-4102
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12104020-4102
STATE OF UTAH DEPARTMENT OF COMMERCE SLP LICENSE
UT
Enumeration date
04/19/2011
Last updated
02/04/2021
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