Individual
LORRAINE MICHELLE IVEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
115 N 200 E, WASHINGTON, UT 84780-1642
(435) 669-8981
Mailing address
115 N 200 E, WASHINGTON, UT 84780-1642
(435) 669-8981
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
901207545-04
ALTIUS
UT
Enumeration date
01/13/2015
Last updated
01/13/2015
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