Individual
MICHAEL RUTLEDGE RIQUINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSW
Contact information
Practice address
750 N 200 W, PROVO, UT 84601-1677
(801) 373-4760
Mailing address
750 NORTH 200 WEST, PROVO, UT 84601
(801) 373-4760
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7990850-3502
UT
Other
Enumeration date
03/13/2012
Last updated
03/13/2012
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