Healthcare Provider Details

I. General information

NPI: 1285464248
Provider Name (Legal Business Name): ELIZABETH ROSE SINCOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 W 400 N
OREM UT
84057-1916
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-3505
  • Fax: 801-714-3520
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14114165-4102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: