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Organization
DEPARTMENT OF COMMUNICATION
Active
Organization
DEPARTMENT OF COMMUNICATION
Active
Other names
Speech, Language Hearing Clinic, Speech, Language Hearing Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN CARTER (BILLING SUPERVISOR)
(801) 587-9447
Entity
Organization
Contact information
Practice address
417 WAKARA WAY, #1112, SALT LAKE CITY, UT 84108-1448
(801) 581-3506
Mailing address
417 WAKARA WAY, #1112, SALT LAKE CITY, UT 84108-1448
(801) 581-3506
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
121638400
WYOMING MEDICAID
WY
01
—
801209200
IDAH MEDICAID
ID
05
—
876000525138
—
UT
Enumeration date
09/20/2006
Last updated
06/11/2019
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