Individual
CAROLYN DIANE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
834 E 320 N, SALEM, UT 84653-5535
(801) 358-9166
Mailing address
834 E 320 N, SALEM, UT 84653-5535
(801) 358-9166
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
167634594
DRIVERS LICENSE
UT
Enumeration date
08/09/2021
Last updated
08/09/2021
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