Individual
JEREMY D GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
293 S MAIN ST, LOGAN, UT 84321-5203
(435) 753-4133
Mailing address
293 S MAIN ST, LOGAN, UT 84321-5203
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
10966451-4101
UT
Other
Enumeration date
12/05/2019
Last updated
12/05/2019
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