Individual
MINDY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
750 N 200 E, PROVO, UT 84606-1705
(801) 373-4760
Mailing address
750 N 200 E, PROVO, UT 84606-1705
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
175727903
UT
Other
Enumeration date
10/30/2012
Last updated
10/30/2012
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