Individual
JESSICA ALYSSE VLISIDES-HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2330 LINCOLN AVE, OGDEN, UT 84401-1304
(248) 410-4677
Mailing address
4374 S MAIN ST UNIT 520, MURRAY, UT 84107-3377
(248) 410-4677
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
11323315-4810
UT
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
01/10/2018
Last updated
04/28/2021
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