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NPI Code Detail

MEDICARE: TIFFANY L BOMAN

MEDICARE: TIFFANY L BOMAN
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 Pathologist7974997-4102UT

General Provider Information

NPI Number : 1770807620
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY L BOMAN
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 : 100 N MARIO CAPECCHI DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84113-1103
Country : US
Telephone Number : 833-577-3422
Fax Number : 801-662-4930
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2010
Last Update Date : 06/15/2026

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Directions to “ TIFFANY L BOMAN ” Practice Location

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