Provider Demographics
NPI:1093189441
Name:GRIFFITH, DAVID (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 IMPERIAL DR
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9574
Mailing Address - Country:US
Mailing Address - Phone:801-403-4718
Mailing Address - Fax:
Practice Address - Street 1:210 IMPERIAL DR
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:UT
Practice Address - Zip Code:84050-9574
Practice Address - Country:US
Practice Address - Phone:801-403-4718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT372742-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist