Provider Demographics
NPI:1073521043
Name:AUDIOLOGY ASSOCIATES OF SALT LAKE CITY, INC.
Entity Type:Organization
Organization Name:AUDIOLOGY ASSOCIATES OF SALT LAKE CITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MCH
Authorized Official - Phone:801-272-1232
Mailing Address - Street 1:1377 E 3900 S
Mailing Address - Street 2:STE 201
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124
Mailing Address - Country:US
Mailing Address - Phone:801-272-1232
Mailing Address - Fax:801-272-1238
Practice Address - Street 1:1377 E 3900 S
Practice Address - Street 2:STE 201
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124
Practice Address - Country:US
Practice Address - Phone:801-272-1232
Practice Address - Fax:801-272-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4831126-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty