Provider Demographics
NPI:1235963430
Name:SMITH, MARGARET JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:JANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2053 E CAMINO WAY
Mailing Address - Street 2:
Mailing Address - City:COTTONWD HTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-4906
Mailing Address - Country:US
Mailing Address - Phone:801-618-6177
Mailing Address - Fax:
Practice Address - Street 1:6787 S REDWOOD RD STE 5
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-2404
Practice Address - Country:US
Practice Address - Phone:801-839-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14035372-2504103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist