Provider Demographics
NPI:1568587053
Name:HEALY, CARRIE ELLEN (STUDENT AND HEALTH)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ELLEN
Last Name:HEALY
Suffix:
Gender:F
Credentials:STUDENT AND HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 E 600 S
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-5046
Mailing Address - Country:US
Mailing Address - Phone:602-980-7607
Mailing Address - Fax:
Practice Address - Street 1:605 E 600 S
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-5046
Practice Address - Country:US
Practice Address - Phone:602-980-7607
Practice Address - Fax:602-980-7607
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator