Provider Demographics
NPI:1013694108
Name:UTAH PEDIATRIC SPEECH
Entity Type:Organization
Organization Name:UTAH PEDIATRIC SPEECH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:801-836-0166
Mailing Address - Street 1:1922 GLENDON CIR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8568
Mailing Address - Country:US
Mailing Address - Phone:801-836-0166
Mailing Address - Fax:801-785-6641
Practice Address - Street 1:1922 GLENDON CIR
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-8568
Practice Address - Country:US
Practice Address - Phone:801-836-0166
Practice Address - Fax:801-785-6641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech