Provider Demographics
NPI:1124326889
Name:MEDELLIN, ISABEL
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:MEDELLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 CAPE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84128-5626
Mailing Address - Country:US
Mailing Address - Phone:801-706-0887
Mailing Address - Fax:
Practice Address - Street 1:4621 CAPE RIDGE LN
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84128-5626
Practice Address - Country:US
Practice Address - Phone:801-706-0887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor