Provider Demographics
NPI:1710319058
Name:SNOW, STACEY CLAIRE (AUD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:CLAIRE
Last Name:SNOW
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 S 700 E
Mailing Address - Street 2:#10
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2180
Mailing Address - Country:US
Mailing Address - Phone:801-268-4141
Mailing Address - Fax:877-357-0718
Practice Address - Street 1:5770 S 250 E
Practice Address - Street 2:#285
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8100
Practice Address - Country:US
Practice Address - Phone:801-268-2822
Practice Address - Fax:801-268-2832
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8745012-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist