Provider Demographics
NPI:1083245690
Name:BOOZ, JAIME ALDEN
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ALDEN
Last Name:BOOZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:ALDEN
Other - Last Name:BOOZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:655 E 3065 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1350
Mailing Address - Country:US
Mailing Address - Phone:801-647-5691
Mailing Address - Fax:
Practice Address - Street 1:1012 W JORDAN RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-4865
Practice Address - Country:US
Practice Address - Phone:801-647-5691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-01
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10231059-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty