Individual
MICHELLE ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSUDC
Contact information
Practice address
7601 S REDWOOD RD, WEST JORDAN, UT 84084-4007
(801) 233-8670
(801) 233-8682
Mailing address
7601 S REDWOOD RD, WEST JORDAN, UT 84084-4007
(801) 233-8670
(801) 233-8682
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
9153574-6005
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306010574
—
UT
Enumeration date
09/15/2014
Last updated
09/15/2014
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