Individual
IVY DESDEMONA MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
370 E HERBERT AVE APT B, SALT LAKE CITY, UT 84111-4743
(775) 340-9555
Mailing address
370 E HERBERT AVE APT B, SALT LAKE CITY, UT 84111-4743
(775) 340-9555
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/16/2021
Last updated
05/16/2021
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