Provider Demographics
NPI:1578718722
Name:CVETKO, ROBERT (HIS INT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CVETKO
Suffix:
Gender:M
Credentials:HIS INT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4605
Mailing Address - Country:US
Mailing Address - Phone:801-225-2222
Mailing Address - Fax:801-426-4867
Practice Address - Street 1:63 W CENTER ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4605
Practice Address - Country:US
Practice Address - Phone:801-225-2222
Practice Address - Fax:801-426-4867
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT318586-4602237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist