Provider Demographics
NPI:1972493138
Name:MERRILL, MARDEE OLPIN (MED)
Entity type:Individual
Prefix:
First Name:MARDEE
Middle Name:OLPIN
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 S 50 W
Mailing Address - Street 2:
Mailing Address - City:WEST BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5559
Mailing Address - Country:US
Mailing Address - Phone:801-548-3091
Mailing Address - Fax:801-992-7150
Practice Address - Street 1:2025 S 50 W
Practice Address - Street 2:
Practice Address - City:WEST BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5559
Practice Address - Country:US
Practice Address - Phone:801-548-3091
Practice Address - Fax:801-992-7150
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician