Provider Demographics
NPI:1629575378
Name:KLEIN, ERIC (MS SLP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2548
Mailing Address - Country:US
Mailing Address - Phone:415-341-3066
Mailing Address - Fax:
Practice Address - Street 1:575 E 1400 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7707
Practice Address - Country:US
Practice Address - Phone:415-341-3066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10501885-4104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist