Individual
MICHAELA GOODLOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1040 S 500 W, BRIGHAM CITY, UT 84302-5599
(801) 864-8164
Mailing address
52 E SPRING CREEK PKWY, PROVIDENCE, UT 84332-9828
(801) 864-8164
Taxonomy
Speciality
Code
Description
License number
State
225A00000X
Music Therapist
13482080-4010
UT
226000000X
Recreational Therapist Assistant
Primary
13482080-4003
UT
Other
Enumeration date
07/10/2019
Last updated
04/09/2024
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