Individual
RAEGAN OWEN VELASQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
344 E 100 S, SALT LAKE CITY, UT 84111-1700
(801) 573-3213
Mailing address
129 S 700 E, APARTMENT 5, SALT LAKE CITY, UT 84102-4237
(801) 647-4255
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
101YA0400X
UT
Other
Enumeration date
05/03/2016
Last updated
08/10/2016
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