Healthcare Provider Details

I. General information

NPI: 1225614704
Provider Name (Legal Business Name): MEG FROST CCC-SLP, LSLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1682 E YALE AVE
SALT LAKE CITY UT
84105-1720
US

IV. Provider business mailing address

1682 E YALE AVE
SALT LAKE CITY UT
84105-1720
US

V. Phone/Fax

Practice location:
  • Phone: 718-612-2318
  • Fax:
Mailing address:
  • Phone: 718-612-2318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number12113552-4102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number23254
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number23254
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12113552-4102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: