Healthcare Provider Details

I. General information

NPI: 1366231110
Provider Name (Legal Business Name): IGNITE ORAL FUNCTION THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 W CHAPPEL VALLEY LOOP
LEHI UT
84043-3920
US

IV. Provider business mailing address

583 W CHAPPEL VALLEY LOOP
LEHI UT
84043-3920
US

V. Phone/Fax

Practice location:
  • Phone: 801-899-9876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA3000X
TaxonomyAugmentative Communication Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KRISTINE ANDRUS
Title or Position: OWNER
Credential: M.S., CCC-SLP, CMT
Phone: 801-899-9876