| Buffalo Wellness | |
|
3486 S Sorenson Way Salt Lake City UT 84109-3114 | |
| (406) 239-0401 | |
| Not Available |
| Full Name | Buffalo Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 3486 S Sorenson Way, Salt Lake City, Utah |
| Authorized Official Name and Position | Kasandra Lundquist (OWNER) |
| Authorized Official Contact | 4062390401 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Buffalo Wellness 3486 S Sorenson Way Salt Lake City UT 84109-3114 Ph: (406) 239-0401 | Buffalo Wellness 3486 S Sorenson Way Salt Lake City UT 84109-3114 Ph: (406) 239-0401 |
| NPI Number | 1346959038 |
|---|---|
| Provider Enumeration Date | 11/21/2022 |
| Last Update Date | 11/21/2022 |
| Certification Date | 11/21/2022 |
| Medicare PECOS PAC ID | 7214394949 |
|---|---|
| Medicare Enrollment ID | O20230612000482 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346959038 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kasandra Lundquist |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306325683 PECOS PAC ID: 8628444569 Enrollment ID: I20221018003716 |
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