Individual
VICKIE DAWN SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5965 S 900 E, SALT LAKE CITY, UT 84121-1720
(801) 263-7100
Mailing address
5965 S 900 E, SALT LAKE CITY, UT 84121-1720
(801) 263-7100
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
4947436-6006
UT
101YM0800X
Mental Health Counselor
Primary
4947436-3503
UT
Other
Enumeration date
03/09/2011
Last updated
03/09/2011
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