Individual
MARY GULLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
177 W PRICE AVE, SALT LAKE CITY, UT 84115-4345
(385) 468-4548
Mailing address
177 W PRICE AVE, SALT LAKE CITY, UT 84115-4345
(385) 468-4548
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
876000316
—
UT
Enumeration date
04/08/2014
Last updated
04/08/2014
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