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General NPI Number Information
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NPI Number | 1114465838
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Entity Type | Organization
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Legal Business Name | BYU SPEECH AND LANGUAGE CLINIC
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 02/01/2017
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Provider Practice Location Address
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Address Line | 1190 N 900 E
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City | PROVO
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State | UT
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Zip | 84604-3536
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Country | US
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Telephone | 801-422-5117
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Fax |
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Provider Business Mailing Address
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Address Line | 1190 N 900 E 163 TLRB
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City | PROVO
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State | UT
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Zip | 84604-3536
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | LEE ROBINSON
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Credential | M.S., CCC-SLP
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Telephone | 801-422-7650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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