Healthcare Provider Details

I. General information

NPI: 1639644347
Provider Name (Legal Business Name): YOLANDA SUE BROWN MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 N 2000 W
CLINTON UT
84015-8562
US

IV. Provider business mailing address

1407 N 2000 W
CLINTON UT
84015-8562
US

V. Phone/Fax

Practice location:
  • Phone: 801-668-5396
  • Fax:
Mailing address:
  • Phone: 801-784-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6182383-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: