Provider Demographics
NPI:1235374984
Name:UTAH STATE UNIVERSITY
Entity Type:Organization
Organization Name:UTAH STATE UNIVERSITY
Other - Org Name:SPEECH LANGUAGE HEARING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-797-5830
Mailing Address - Street 1:6410 OLD MAIN HL
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84322-6410
Mailing Address - Country:US
Mailing Address - Phone:435-797-1346
Mailing Address - Fax:844-308-5865
Practice Address - Street 1:6410 OLD MAIN HL
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-6410
Practice Address - Country:US
Practice Address - Phone:435-797-1346
Practice Address - Fax:844-308-5865
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UTAH STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-10
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty