Individual
SARA LEE TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-A
Contact information
Practice address
VA MEDICAL CTR, 500 FOOTHILL BLVD., SALT LAKE CITY, UT 84148-0001
(801) 584-1242
Mailing address
33 E 200 N, NORTH SALT LAKE, UT 84054-2420
(801) 299-9416
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
3162644101
UT
Other
Enumeration date
06/24/2006
Last updated
07/08/2007
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