| Renew | |
|
63 E 11400 S #103 Sandy UT 84070-6705 | |
| (801) 971-2075 | |
| (801) 943-0599 |
| Full Name | Renew |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 63 E 11400 S, Sandy, Utah |
| Authorized Official Name and Position | Deborah Marie Wayman (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8019712075 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Renew 63 E 11400 S #103 Sandy UT 84070-6705 Ph: (801) 971-2075 | Renew 63 E 11400 S #103 Sandy UT 84070-6705 Ph: (801) 971-2075 |
| NPI Number | 1447592811 |
|---|---|
| Provider Enumeration Date | 03/22/2013 |
| Last Update Date | 08/08/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447592811 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 4780650-6004 (Utah) | Primary |
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