Organization
RE THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALYCEN DECOSTA CCC-SLP (OWNER)
(801) 210-9319
Entity
Organization
Contact information
Practice address
397 S 200 E, SPANISH FORK, UT 84660
(801) 210-9319
Mailing address
397 S 200 E, SPANISH FORK, UT 84660-2416
(801) 210-9319
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/29/2017
Last updated
07/21/2022
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