Most Relevant Information
Provider Data
| NPI Number: | 1003214867 |
| Provider Name: | MIRA WISWELL |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/10/2014 |
| Last Updated: | 12/10/2014 |
Provider Practice Location
5965 S 900 E
MURRAY
UT
841211720
Practice Location Phone/Fax
| Phone: | 8012637138 |
| Fax: |
Provider Mailing Location
5965 S 900 E
MURRAY
UT
841211720
Provider Mailing Phone/Fax
| Phone: | 8012637138 |
| Fax: |