Individual
DIANE NILSSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
425 MEDICAL DR STE 122, BOUNTIFUL, UT 84010-4956
(385) 275-0492
(385) 275-6764
Mailing address
425 MEDICAL DR STE 122, BOUNTIFUL, UT 84010-4956
(385) 275-0492
(385) 275-6764
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3261344102
UT
Other
Enumeration date
06/24/2016
Last updated
06/24/2016
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