Healthcare Provider Details

I. General information

NPI: 1417575952
Provider Name (Legal Business Name): MS. FEBEE'S SPEECH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S 600 W
CENTERVILLE UT
84014-2110
US

IV. Provider business mailing address

330 S 600 W
CENTERVILLE UT
84014-2110
US

V. Phone/Fax

Practice location:
  • Phone: 801-712-6228
  • Fax: 801-218-4040
Mailing address:
  • Phone: 801-712-6228
  • Fax: 801-218-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: FEBEE ICARD
Title or Position: OWNER, SLP
Credential:
Phone: 801-712-6228