Basic Information
| Provider Information | |||||||||
| NPI: | 1114537149 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAGGBOY | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 867 | ||||||||
| Address2: | |||||||||
| City: | PRICE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 845010867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356377200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 198 E CENTER ST | ||||||||
| Address2: | |||||||||
| City: | MOAB | ||||||||
| State: | UT | ||||||||
| PostalCode: | 845322430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4352596131 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2020 | ||||||||
| LastUpdateDate: | 08/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 8607597-3502 | UT | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.