Organization
INTERMOUNTAIN HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUDRUN ULRIKE MIRIN LCSW (CLINICAL SOCIAL WORKER)
(801) 408-8500
Entity
Organization
Contact information
Practice address
324 E 10TH AVE STE 178, SALT LAKE CITY, UT 84103-2885
(801) 408-8500
Mailing address
324 E 10TH AVE STE 178, SALT LAKE CITY, UT 84103-2885
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
932611213501
UT
Other
Enumeration date
10/17/2013
Last updated
10/17/2013
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