Provider Demographics
NPI:1225297104
Name:MOSIER-MALMBORG, ELISABETH ANNE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:ANNE
Last Name:MOSIER-MALMBORG
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:ELISABETH
Other - Middle Name:ANNE
Other - Last Name:MOSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:PO BOX 522236
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84152-2236
Mailing Address - Country:US
Mailing Address - Phone:801-810-9145
Mailing Address - Fax:
Practice Address - Street 1:3135 S 600 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1215
Practice Address - Country:US
Practice Address - Phone:801-810-9145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT47678904102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist