Healthcare Provider Details

I. General information

NPI: 1336073386
Provider Name (Legal Business Name): CYNTHIA TERRY SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 N MEDICAL DR
SALT LAKE CITY UT
84112-1100
US

IV. Provider business mailing address

1039 E LOGAN AVE
SALT LAKE CITY UT
84105-2409
US

V. Phone/Fax

Practice location:
  • Phone: 801-646-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14290303-4102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: