Individual
ANNA TEDIE DISERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2872 S HIGHLAND DR, SALT LAKE CITY, UT 84106-3147
(801) 485-8051
Mailing address
7933 W BRITTAIN DR, MAGNA, UT 84044-3226
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
12288146-3502
UT
Other
Enumeration date
08/05/2021
Last updated
08/05/2021
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