Provider Demographics
NPI:1023210770
Name:OGDEN SPEECH AND HEARING CENTER, INC.
Entity Type:Organization
Organization Name:OGDEN SPEECH AND HEARING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:801-399-5601
Mailing Address - Street 1:978 CHAMBERS ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4861
Mailing Address - Country:US
Mailing Address - Phone:801-399-5601
Mailing Address - Fax:801-394-2230
Practice Address - Street 1:978 CHAMBERS ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4861
Practice Address - Country:US
Practice Address - Phone:801-399-5601
Practice Address - Fax:801-394-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106698-4101237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057814Medicare ID - Type UnspecifiedAUDIOLOGY