Provider Demographics
NPI:1093937864
Name:OBERG, LAURIE K (AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:K
Last Name:OBERG
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 W 4050 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84414-2739
Mailing Address - Country:US
Mailing Address - Phone:801-592-8109
Mailing Address - Fax:
Practice Address - Street 1:9361 S 300 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2902
Practice Address - Country:US
Practice Address - Phone:801-826-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT373028-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT999000021033Medicaid