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Individual

LACEY MARIE FERGUSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
6856 S 700 E, MIDVALE, UT 84047-5772
(801) 743-6100
Mailing address
4460 S HIGHLAND DR, SALT LAKE CITY, UT 84124-3543

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Enumeration date
09/11/2018
Last updated
09/11/2018
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