Active NPI
Micah Slack
- Behavior Analyst
- South Ogden, UT
National Provider Identifier
1740776426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 12254646-2506
- Practice address
- 6033 Fashion Point Dr
South Ogden, UT 84403-4847 - Phone
- (605) 271-2690
- NPI assigned
- Jul 6, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Behavior Analyst | 103K00000X | 12254646-2506 | UT | Primary |
Addresses
Primary practice location
6033 Fashion Point Dr
South Ogden, UT 84403-4847
Mailing address
3697 Oakridge Dr
Bountiful, UT 84010-5864
Phone (928) 388-8494
Other practice location 1
1438 N Highway 89 Ste 130
Farmington, UT 84025-2737
Phone (605) 271-2690
Other practice location 2
515 700 E
Suite 2A
Salt Lake City, UT 84102
Phone (801) 935-4171
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12254646-2506 | UT | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aim-Autism in Motion, Corp | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Behavior Analyst
- Farr West, UT
- NPI 1407342058
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687305600000",
"number": "1740776426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3697 OAKRIDGE DR",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "840105864",
"telephone_number": "928-388-8494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6033 FASHION POINT DR",
"city": "SOUTH OGDEN",
"state": "UT",
"postal_code": "844034847",
"telephone_number": "605-271-2690"
}
],
"practiceLocations": [
{
"address_1": "1438 N Highway 89 Ste 130",
"address_purpose": "LOCATION",
"city": "Farmington",
"state": "UT",
"postal_code": "840252737",
"country_code": "US",
"telephone_number": "605-271-2690",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "515 700 E",
"address_2": "Suite 2A",
"address_purpose": "LOCATION",
"city": "Salt Lake City",
"state": "UT",
"postal_code": "84102",
"country_code": "US",
"telephone_number": "801-935-4171",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SLACK",
"first_name": "MICAH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-06",
"last_updated": "2023-06-21",
"certification_date": "2023-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "UT",
"license": "12254646-2506",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Ogden, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.