Individual
TIP BOUNYASANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7901 S 3200 W # 632, WEST JORDAN, UT 84088-5226
(801) 556-4037
Mailing address
PO BOX 632, WEST JORDAN, UT 84084-0632
(801) 556-4037
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
F24-113176
UT
Other
Enumeration date
11/16/2023
Last updated
12/30/2025
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