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General NPI Number Information
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NPI Number | 1699008383
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Entity Type | Organization
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Legal Business Name | UTAH HEARING AND BALANCE CENTER, LLC
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Dates
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Enumeration Date | 09/12/2009
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Last Update Date | 09/12/2009
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Provider Practice Location Address
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Address Line | 8806 S REDWOOD RD SUITE 103
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City | WEST JORDAN
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State | UT
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Zip | 84088-9337
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Country | US
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Telephone | 801-495-4801
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Fax | 801-432-7107
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Provider Business Mailing Address
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Address Line | 8806 S REDWOOD RD SUITE 103
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City | WEST JORDAN
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State | UT
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Zip | 84088-9337
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Country | US
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Telephone | 801-495-4801
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Fax | 801-432-7107
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOLLY MALISSA LEROY
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Credential | AUD
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Telephone | 801-205-6207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 48306964101
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License Number State | UT
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