Individual
MENDOCINO NICOLE PEACOCK ADZAGAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
5770 S FASHION BOULEVARD, BUILDING 5 SUITE 210, MURRAY, UT 84107
(833) 577-3422
Mailing address
5770 S FASHION BLVD, BLDG #5, SUITE 210, MURRAY, UT 84107-6330
(801) 314-5241
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
CF7205
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
.
NONE
—
Enumeration date
05/21/2021
Last updated
10/18/2022
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