Healthcare Provider Details

I. General information

NPI: 1528865896
Provider Name (Legal Business Name): SOUTHWEST DYSPHAGIA SOLUTIONS, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 04/30/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 S 2450 E APT 31
ST GEORGE UT
84790-2552
US

IV. Provider business mailing address

316 S 2450 E APT 31
ST GEORGE UT
84790-2552
US

V. Phone/Fax

Practice location:
  • Phone: 801-682-9800
  • Fax:
Mailing address:
  • Phone: 801-682-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JODI WINN
Title or Position: CEO/SLP
Credential: SLP
Phone: 801-682-9800