Provider Demographics
NPI:1508872177
Name:SUMMIT COUNTY EARLY INTERVENTION
Entity Type:Organization
Organization Name:SUMMIT COUNTY EARLY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUESANNEB
Authorized Official - Middle Name:O
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:BSECE
Authorized Official - Phone:435-615-3925
Mailing Address - Street 1:6505 LANDMARK DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5999
Mailing Address - Country:US
Mailing Address - Phone:435-615-3925
Mailing Address - Fax:435-615-3926
Practice Address - Street 1:6505 LANDMARK DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5999
Practice Address - Country:US
Practice Address - Phone:435-615-3925
Practice Address - Fax:435-615-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251C00000X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT251C00000XMedicaid