Individual
MIKAELA SUE JORGENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MAT, LAT, ATC
Contact information
Practice address
150 E BULLDOG BLVD, PROVO, UT 84604-2676
(801) 422-4636
Mailing address
14133 S ENSIGN PEAK CIR, RIVERTON, UT 84096-6415
(801) 819-8705
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
13416952-4810
UT
Other
Enumeration date
11/21/2023
Last updated
11/21/2023
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