Provider Demographics
NPI:1194181362
Name:BATEMAN, ROBERT (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BATEMAN
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 1:515 MARVA AVE
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-2626
Mailing Address - Country:US
Mailing Address - Phone:801-645-2973
Mailing Address - Fax:
Practice Address - Street 1:444 DIXIE AVE
Practice Address - Street 2:LAYTON
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-3226
Practice Address - Country:US
Practice Address - Phone:801-546-6905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9461560-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist