Individual
HERU HENDARTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD,MS, CCC-SLP
Contact information
Practice address
755 JUSTIN KAY CT, SALT LAKE CITY, UT 84104-1619
(801) 599-7471
(801) 956-0741
Mailing address
755 JUSTIN KAY CT, SALT LAKE CITY, UT 84104-1619
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4841650-4102
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4841650-4102
STATE SLP LISENCE
UT
Enumeration date
10/20/2010
Last updated
10/20/2010
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