Provider Demographics
NPI:1316553811
Name:MIDGLEY, SARAH JANE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:MIDGLEY
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 1:8147 S MOUNT SPENCER CIR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5937
Mailing Address - Country:US
Mailing Address - Phone:801-403-3659
Mailing Address - Fax:
Practice Address - Street 1:8147 S MOUNT SPENCER CIR
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5937
Practice Address - Country:US
Practice Address - Phone:801-403-3659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician