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1255084067
ELAINE MCKIBBIN
SALT LAKE CITY, UT
NPI
1255084067
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Other Name
ELAINE LAINE MCKIBBIN
Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2022-02-01
Last Update Date
2022-02-01
Business Address
ELAINE MCKIBBIN
344 E 100 S STE 301
SALT LAKE CITY, UT 84111-1727
Phone number: 801-428-4257
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Mailing Address
ELAINE MCKIBBIN
380 S 400 E APT 427
SALT LAKE CITY, UT 84111-2933
Phone number: 435-901-3921
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