Organization
MOUNTAIN WEST HEARING AND SPEECH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD S VAN WAGONER M.S. CCC-A (PRESIDENT)
(801) 268-6497
Entity
Organization
Contact information
Practice address
777 E 4500 S STE 110, SALT LAKE CITY, UT 84107-3056
(801) 268-6497
(801) 268-1376
Mailing address
777 E 4500 S STE 110, SALT LAKE CITY, UT 84107-3056
(801) 268-6497
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
104094-4101
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528609027002
—
UT
Enumeration date
03/22/2007
Last updated
08/22/2020
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