Individual
TINA SEVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8330 S 2200 W, WEST JORDAN, UT 84088-9514
(801) 255-8220
Mailing address
8330 S 2200 W, WEST JORDAN, UT 84088-9514
(801) 255-8220
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
08/08/2019
Last updated
08/08/2019
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