Basic Information
| Provider Information | |||||||||
| NPI: | 1174177984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNEED | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1443 W 800 N | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840572875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016554950 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4905 S 1500 W STE 110 | ||||||||
| Address2: | |||||||||
| City: | RIVERDALE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844057176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018206420 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2019 | ||||||||
| LastUpdateDate: | 07/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-19-2913-159245 | UT | Y |
No ID Information.