Provider Demographics
NPI:1467865816
Name:ROBERTS, DANIEL
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5349 ADAMS AVE PKWY
Mailing Address - Street 2:STE C
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5349 ADAMS AVE PKWY
Practice Address - Street 2:STE C
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4736
Practice Address - Country:US
Practice Address - Phone:801-479-3346
Practice Address - Fax:801-479-0725
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
UT10343236237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist