Individual
TAYLOR WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2791 S 2475 E, SALT LAKE CTY, UT 84109-1825
(801) 631-6285
Mailing address
2791 S 2475 E, SALT LAKE CTY, UT 84109-1825
(801) 631-6285
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
08/09/2019
Last updated
08/09/2019
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