Individual
TERA ETTINGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SUDC
Contact information
Practice address
901 S OREM BLVD, OREM, UT 84058-5011
(801) 465-5111
Mailing address
901 S OREM BLVD, OREM, UT 84058-5011
(801) 465-5111
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
09/28/2018
Last updated
09/28/2018
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