MEDICARE: WASATCH SPEECH & LANGUAGE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	110090-4102	UT

General Provider Information

NPI Number	:	1063438620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASATCH SPEECH & LANGUAGE CENTER

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84011-0307
Country	:	US
Telephone Number	:	888-700-6907
Fax Number	:	801-294-6917

Provider Business Practice Location Address
First Line	:	2120 E 3900 S
Second Line	:	SUITE 100
City	:	HOLLADAY
State	:	UT
Zip	:	84124-1771
Country	:	US
Telephone Number	:	801-308-0400
Fax Number	:	801-308-0401

Authorized Official
Title or Position	:	OWNER
Name	:	MR. THOMAS GURRISTER
Credential	:	MS CCC
Telephone Number	:	801-308-0400

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	08/22/2020

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Directions to “WASATCH SPEECH & LANGUAGE CENTER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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