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NPI Code Detail

MEDICARE: MS. SHARON AMY VINICK SLP-CCC

MEDICARE: MS. SHARON AMY VINICK SLP-CCC
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
1235Z00000XSpeech-Language Pathologist57216744102UT

General Provider Information

NPI Number : 1467598854
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHARON AMY VINICK SLP-CCC
Provider Business Mailing Address
First Line : 756 ELGIN AVE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1602
Country : US
Telephone Number : 801-865-4614
Fax Number :
Provider Business Practice Location Address
First Line : 1952 FORT UNION BLVD
Second Line : SUITE 100
City : SALT LAKE CITY
State : UT
Zip : 84121-6877
Country : US
Telephone Number : 801-942-3311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 07/08/2007

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