Individual
LESA TERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
447 W BEARCAT DR, SOUTH SALT LAKE, UT 84115-2519
(801) 355-2846
Mailing address
447 W BEARCAT DR, SOUTH SALT LAKE, UT 84115-2519
(801) 355-2846
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/29/2022
Last updated
08/29/2022
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