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General NPI Number Information
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NPI Number | 1316304918
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Entity Type | Organization
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Legal Business Name | INTERMOUNTAIN HEALTHCARE
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Dates
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Enumeration Date | 01/27/2016
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Last Update Date | 01/27/2016
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Provider Practice Location Address
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Address Line | 1034 N 500 W SPEECH AND HEARING
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City | PROVO
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State | UT
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Zip | 84604-3380
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Country | US
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Telephone | 801-357-7448
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Fax |
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Provider Business Mailing Address
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Address Line | 1034 N 500 W
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City | PROVO
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State | UT
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Zip | 84604-3380
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Country | US
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Telephone | 801-357-7448
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | MS. ASHLEE SPARROW
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Credential | M.S., CCC/SLP
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Telephone | 435-881-3660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | 90852634102
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License Number State | UT
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