MEDICARE: UTAH PEDIATRIC SPEECH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1013694108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UTAH PEDIATRIC SPEECH

Provider Business Mailing Address
First Line	:	1922 GLENDON CIR
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-8568
Country	:	US
Telephone Number	:	801-836-0166
Fax Number	:	801-785-6641

Provider Business Practice Location Address
First Line	:	1922 GLENDON CIR
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-8568
Country	:	US
Telephone Number	:	801-836-0166
Fax Number	:	801-785-6641

Authorized Official
Title or Position	:	OWNER/SPEECH PATHOLOGIST
Name	:	PAIGE CRAWLEY
Credential	:	M.S. CCC-SLP
Telephone Number	:	801-836-0166

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	06/29/2023

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