MEDICARE: ANDREA CHI-LING BAE CCC-SLP

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

General Provider Information

NPI Number	:	1760031868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA CHI-LING BAE CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 30180
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84130-0180
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3845 W 4700 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84129-3454
Country	:	US
Telephone Number	:	801-840-4360
Fax Number	:

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

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	04/13/2026

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