Individual
PHOEBE BERGVALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
344 E 100 S, SALT LAKE CITY, UT 84111-1700
(801) 322-4257
Mailing address
458 3RD AVE., #7, SALT LAKE CITY, UT 84103
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/19/2011
Last updated
11/19/2011
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