MEDICARE: UTAH HEARING AND BALANCE CENTER, LLC

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	231H00000X	Audiologist	48306964101	UT

General Provider Information

NPI Number	:	1699008383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UTAH HEARING AND BALANCE CENTER, LLC

Provider Business Mailing Address
First Line	:	8806 S REDWOOD RD
Second Line	:	SUITE 103
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-9337
Country	:	US
Telephone Number	:	801-495-4801
Fax Number	:	801-432-7107

Provider Business Practice Location Address
First Line	:	8806 S REDWOOD RD
Second Line	:	SUITE 103
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-9337
Country	:	US
Telephone Number	:	801-495-4801
Fax Number	:	801-432-7107

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MOLLY MALISSA LEROY
Credential	:	AUD
Telephone Number	:	801-205-6207

Provider Enumeration Date	:	09/12/2009
Last Update Date	:	09/12/2009

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