Individual
DESTENEE MARIE EARL MATHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
344 E 100 S STE 301, SALT LAKE CITY, UT 84111-1727
(801) 428-4257
Mailing address
3331 S MAGNOLIA DR, MAGNA, UT 84044-2126
(818) 916-5875
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/30/2021
Last updated
10/08/2021
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