MEDICARE: JEANINE LYONS

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

General Provider Information

NPI Number	:	1841937737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANINE LYONS

Provider Business Mailing Address
First Line	:	554 N 950 E
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-4550
Country	:	US
Telephone Number	:	801-836-7586
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 E 3900 S
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84124-1300
Country	:	US
Telephone Number	:	801-836-7586
Fax Number	:

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

Provider Enumeration Date	:	05/12/2022
Last Update Date	:	05/12/2022

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Directions to “ JEANINE LYONS ” Practice Location

Language	Start Address	Practice Location

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