Provider Demographics
NPI:1790031581
Name:WIDENER, TAYLOR DENISE (AUD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DENISE
Last Name:WIDENER
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 1:9722 SWEET BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3216
Mailing Address - Country:US
Mailing Address - Phone:801-897-6188
Mailing Address - Fax:
Practice Address - Street 1:9722 SWEET BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3216
Practice Address - Country:US
Practice Address - Phone:801-897-6188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8375449-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist