Healthcare Provider Details

I. General information

NPI: 1730737032
Provider Name (Legal Business Name): TIFFANY LEE MS.CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4090 W PIONEER PKWY
WEST VALLEY CITY UT
84120-2060
US

IV. Provider business mailing address

13279 S HERRIMAN ROSE BLVD
HERRIMAN UT
84096-5729
US

V. Phone/Fax

Practice location:
  • Phone: 801-397-4440
  • Fax:
Mailing address:
  • Phone: 585-955-3023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12436784-4102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: