Individual
MARY THIBODEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
344 E 100 S, STE 301, SALT LAKE CITY, UT 84111-1700
(801) 322-4257
(801) 478-2686
Mailing address
344 E 100 S, STE 301, SALT LAKE CITY, UT 84111-1700
(801) 322-4257
(801) 478-2686
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
08/17/2016
Last updated
08/17/2016
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