MEDICARE: MS. LAURIE DON FUE MS.,CCC-SLP

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	235Z00000X	Speech-Language Pathologist	108295-4102	UT

General Provider Information

NPI Number	:	1780939025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE DON FUE MS.,CCC-SLP

Provider Business Mailing Address
First Line	:	417 S WAKARA WAY
Second Line	:	STE 1112
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1448
Country	:	US
Telephone Number	:	801-263-3194
Fax Number	:

Provider Business Practice Location Address
First Line	:	596 E 3990 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-1918
Country	:	US
Telephone Number	:	801-263-3194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2012
Last Update Date	:	12/10/2021

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