MEDICARE: SHELLY LEE HAMULA

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	366761-4402	UT

General Provider Information

NPI Number	:	1073692547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY LEE HAMULA

Provider Business Mailing Address
First Line	:	1801 HUBBARD AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108
Country	:	US
Telephone Number	:	801-582-3292
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 S 1700 E
Second Line	:	SUITE 211
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-2273
Country	:	US
Telephone Number	:	801-581-1307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	03/03/2008

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Directions to “ SHELLY LEE HAMULA ” Practice Location

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