| Wasatch Back Venture Trail | |
|
3585 N University Ave Ste 250 Provo UT 84604-6622 | |
| (435) 513-2715 | |
| Not Available |
| Full Name | Wasatch Back Venture Trail |
|---|---|
| Speciality | Social Worker |
| Location | 3585 N University Ave Ste 250, Provo, Utah |
| Authorized Official Name and Position | Megan Perry (OWNER) |
| Authorized Official Contact | 4355132715 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wasatch Back Venture Trail 3585 N University Ave Ste 250 Provo UT 84604-6622 Ph: (435) 513-2715 | Wasatch Back Venture Trail 3585 N University Ave Ste 250 Provo UT 84604-6622 Ph: (435) 513-2715 |
| NPI Number | 1407466089 |
|---|---|
| Provider Enumeration Date | 08/07/2020 |
| Last Update Date | 08/07/2020 |
| Certification Date | 08/07/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407466089 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
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