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General NPI Number Information
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NPI Number | 1679095491
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Entity Type | Organization
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Legal Business Name | SPEECH THERAPY UNBOXED
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 07/13/2017
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Provider Practice Location Address
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Address Line | 447 N 300 W STE 8
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City | KAYSVILLE
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State | UT
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Zip | 84037-4203
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Country | US
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Telephone | 703-217-9331
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Fax |
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Provider Business Mailing Address
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Address Line | 265 N MAIN ST STE D #191
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City | KAYSVILLE
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State | UT
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Zip | 84037
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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 | SPEECH LANGUAGE PATHOLOGIST
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Name | BREANNA NELSON
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Credential | M.S. CCC-SLP
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Telephone | 703-217-9331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 6574955-4102
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License Number State | UT
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