Individual
STACEY CLARDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D. PH.D.
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0100
(801) 585-6387
Mailing address
PO BOX 413027, SALT LAKE CITY, UT 84141-3027
(801) 213-3900
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
8615909-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
Enumeration date
05/02/2007
Last updated
11/12/2021
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