Healthcare Provider Details

I. General information

NPI: 1053258996
Provider Name (Legal Business Name): SUZANNE SMITH SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10434 S 4000 W
SOUTH JORDAN UT
84009-5729
US

IV. Provider business mailing address

10657 S VERMILLION DR
SOUTH JORDAN UT
84009-5726
US

V. Phone/Fax

Practice location:
  • Phone: 801-755-3151
  • Fax:
Mailing address:
  • Phone: 801-755-3151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6885563-4102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: