Individual
ALYCEN FIELDING DECOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
397 S 200 E, SPANISH FORK, UT 84660
(801) 210-9319
Mailing address
727 S MAIN ST, SPANISH FORK, UT 84660-2449
(435) 231-4112
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
10144790-4102
UT
Other
Enumeration date
08/30/2017
Last updated
05/25/2018
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