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1740250372
RICHARD WAYNE MICKELSEN
PROVO, UT
NPI
1740250372
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry
(Licence: UT 5336032-1205)
Enumeration Date
2006-01-25
Last Update Date
2023-08-03
Business Address
DR. RICHARD WAYNE MICKELSEN M.D.
1300 E CENTER ST
PROVO, UT 84606-3554
Phone number: 801-344-4215
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Mailing Address
DR. RICHARD WAYNE MICKELSEN M.D.
1300 E CENTER ST
PROVO, UT 84606-3554
Phone number: 801-344-4400
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