=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437699444
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CACHE VALLEY INTERPRETING AGENCY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2017
-----------------------------------------------------
Last Update Date | 02/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 164 N 100 W
-----------------------------------------------------
City | WELLSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84339-9573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-764-7053
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 246
-----------------------------------------------------
City | WELLSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84339-0246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-764-7053
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JODIE COLEMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 435-764-7052
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171R00000X
-----------------------------------------------------
Taxonomy Name | Interpreter
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------