Provider Demographics
NPI:1184882292
Name:SALT LAKE SPEECH & LANGUAGE INC.
Entity type:Organization
Organization Name:SALT LAKE SPEECH & LANGUAGE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAMULA
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:801-581-1307
Mailing Address - Street 1:1308 S 1700 E
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2273
Mailing Address - Country:US
Mailing Address - Phone:801-581-1307
Mailing Address - Fax:801-581-1306
Practice Address - Street 1:1308 S 1700 E
Practice Address - Street 2:SUITE 211
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2273
Practice Address - Country:US
Practice Address - Phone:801-581-1307
Practice Address - Fax:801-581-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT366761-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528479922001Medicaid