Healthcare Provider Details

I. General information

NPI: 1376278580
Provider Name (Legal Business Name): EMILY HARTMANN MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5848 S 300 E STE G50
MURRAY UT
84107-6170
US

IV. Provider business mailing address

2216 S FOOTHILL DR APT 315G
SALT LAKE CITY UT
84109-3998
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-4100
  • Fax:
Mailing address:
  • Phone: 314-766-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number124689954102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: