Healthcare Provider Details

I. General information

NPI: 1891354965
Provider Name (Legal Business Name): SALLY ANN ZITTING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S COTTONWOOD ST
MURRAY UT
84107-5701
US

IV. Provider business mailing address

11891 S RUSHMORE PARK LN
HERRIMAN UT
84096-5782
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-1247
  • Fax:
Mailing address:
  • Phone: 435-212-3109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11313911-4104
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: