Individual
MARY DANELLE CHUGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
90 E 200 N, LOGAN, UT 84321-4034
(435) 752-0750
(435) 752-7433
Mailing address
PO BOX 264, WESTON, ID 83286-0264
(435) 752-0750
(435) 752-7433
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
990177601002
—
UT
Enumeration date
08/21/2014
Last updated
08/21/2014
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