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Individual

SHAWNA JEAN GILLEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
660 S 200 E STE 308, SALT LAKE CITY, UT 84111-3853
(801) 355-2086
(801) 359-3244
Mailing address
355 DIMAGGIO DR, TOOELE, UT 84074-9297
(801) 355-2846
(801) 359-3244

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
12/09/2010
Last updated
12/09/2010
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