MEDICARE: UTAH AUDIOLOGY & HEARING, 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	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1770870461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UTAH AUDIOLOGY & HEARING, LLC

Provider Business Mailing Address
First Line	:	2041 SIDEWINDER DR
Second Line	:	STE. 1
City	:	PARK CITY
State	:	UT
Zip	:	84060-7465
Country	:	US
Telephone Number	:	435-655-8824
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 SIDEWINDER DR
Second Line	:	STE. 1
City	:	PARK CITY
State	:	UT
Zip	:	84060-7465
Country	:	US
Telephone Number	:	435-655-8824
Fax Number	:

Authorized Official
Title or Position	:	OWNER/AUDIOLOGIST
Name	:	LEANNE NORMAN
Credential	:	AUD
Telephone Number	:	435-655-8824

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	07/01/2011

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