Provider Demographics
NPI:1679500169
Name:HARTLEY, PAULENE (MS,CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:PAULENE
Middle Name:
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:MS,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460657
Mailing Address - Street 2:508 E SILVERCREST COURT
Mailing Address - City:LEEDS
Mailing Address - State:UT
Mailing Address - Zip Code:84746-0657
Mailing Address - Country:US
Mailing Address - Phone:435-879-0618
Mailing Address - Fax:435-879-0740
Practice Address - Street 1:1067 E TABERNACLE ST
Practice Address - Street 2:SUITE 7
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3163
Practice Address - Country:US
Practice Address - Phone:435-634-7608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1889364101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist