Individual
ELAINE LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-2635
Mailing address
248 UNIVERSITY ST, SALT LAKE CITY, UT 84102-2612
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6552204-4102
UT
Other
Enumeration date
06/15/2007
Last updated
07/08/2007
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