Provider Demographics
NPI:1922217850
Name:CACHE VALLEY WOMENS CENTER, PLLC
Entity Type:Organization
Organization Name:CACHE VALLEY WOMENS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:SICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-753-9999
Mailing Address - Street 1:1325 NORTH 600 E
Mailing Address - Street 2:#102
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341
Mailing Address - Country:US
Mailing Address - Phone:435-753-9999
Mailing Address - Fax:435-753-0546
Practice Address - Street 1:1325 NORTH 600 E
Practice Address - Street 2:#102
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341
Practice Address - Country:US
Practice Address - Phone:435-753-9999
Practice Address - Fax:435-753-0546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty