Individual
TRACY ANN DYCHES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 S ORCHARD DR STE 2, NORTH SALT LAKE, UT 84054-1801
(801) 664-6301
Mailing address
200 S ORCHARD DR STE 2, NORTH SALT LAKE, UT 84054-1801
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
LIC201302868
UT
Other
Enumeration date
10/04/2018
Last updated
10/04/2018
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