Provider Demographics
NPI:1235571381
Name:GARCIA, PRISCILLA L (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:L
Last Name:GARCIA
Suffix:
Gender:F
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 1:1469 E 3115 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3453
Mailing Address - Country:US
Mailing Address - Phone:801-953-5921
Mailing Address - Fax:
Practice Address - Street 1:1469 E 3115 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3453
Practice Address - Country:US
Practice Address - Phone:801-953-5921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5330274-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD5304Medicaid