Provider Demographics
NPI:1699008383
Name:UTAH HEARING AND BALANCE CENTER, LLC
Entity Type:Organization
Organization Name:UTAH HEARING AND BALANCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:MALISSA
Authorized Official - Last Name:LEROY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:801-205-6207
Mailing Address - Street 1:8806 S REDWOOD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9337
Mailing Address - Country:US
Mailing Address - Phone:801-495-4801
Mailing Address - Fax:801-432-7107
Practice Address - Street 1:8806 S REDWOOD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9337
Practice Address - Country:US
Practice Address - Phone:801-495-4801
Practice Address - Fax:801-432-7107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-12
Last Update Date:2009-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT48306964101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty