Provider Demographics
NPI:1518422864
Name:MADRIGAL, SHIRLEY (CPSS, FRF)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:CPSS, FRF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3471 S WEST TEMPLE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-4338
Mailing Address - Country:US
Mailing Address - Phone:801-935-4447
Mailing Address - Fax:
Practice Address - Street 1:3471 S WEST TEMPLE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-4338
Practice Address - Country:US
Practice Address - Phone:801-935-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1227175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist