Basic Information
| Provider Information | |||||||||
| NPI: | 1043490469 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEMMON | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 867 | ||||||||
| Address2: | 105 WEST 100 NORTH | ||||||||
| City: | PRICE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356377200 | ||||||||
| FaxNumber: | 4356372377 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 E 100 S | ||||||||
| Address2: | |||||||||
| City: | CASTLE DALE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4353812432 | ||||||||
| FaxNumber: | 4353812542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2007 | ||||||||
| LastUpdateDate: | 11/14/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.