Individual
CHANTEL DIMITRICOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
90 E 200 N, LOGAN, UT 84321
(435) 752-0750
Mailing address
90 E 200 N, LOGAN, UT 84321
(435) 752-0750
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/06/2012
Last updated
09/06/2012
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