Provider Demographics
NPI:1972531028
Name:BOMAN, TEL SKIDMORE (MS, AUD)
Entity Type:Individual
Prefix:MR
First Name:TEL
Middle Name:SKIDMORE
Last Name:BOMAN
Suffix:
Gender:M
Credentials:MS, AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 CHAMBERS ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4861
Mailing Address - Country:US
Mailing Address - Phone:801-399-5601
Mailing Address - Fax:801-394-2230
Practice Address - Street 1:978 CHAMBERS ST
Practice Address - Street 2:SUITE #1
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4861
Practice Address - Country:US
Practice Address - Phone:801-399-5601
Practice Address - Fax:801-394-2230
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106698-4101237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter