Provider Demographics
NPI:1073729679
Name:HOUTZ, DANIEL RUSSELL (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RUSSELL
Last Name:HOUTZ
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:INTERMOUNTAIN VOICE & SWALLOWING CTR
Mailing Address - Street 2:440 D STREET, SUITE 202
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84143-0001
Mailing Address - Country:US
Mailing Address - Phone:801-480-4972
Mailing Address - Fax:801-480-1810
Practice Address - Street 1:INTERMOUNTAIN VOICE & SWALLOWING CTR
Practice Address - Street 2:440 D STREET, SUITE 202
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143-0001
Practice Address - Country:US
Practice Address - Phone:801-480-4972
Practice Address - Fax:801-480-1810
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6574078-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist