Provider Demographics
NPI:1245338920
Name:DEPARTMENT OF COMMUNICATION
Entity type:Organization
Organization Name:DEPARTMENT OF COMMUNICATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-587-9447
Mailing Address - Street 1:417 WAKARA WAY
Mailing Address - Street 2:#1112
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1448
Mailing Address - Country:US
Mailing Address - Phone:801-581-3506
Mailing Address - Fax:
Practice Address - Street 1:417 WAKARA WAY
Practice Address - Street 2:#1112
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1448
Practice Address - Country:US
Practice Address - Phone:801-581-3506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY121638400OtherWYOMING MEDICAID
UT876000525138Medicaid
ID801209200OtherIDAH MEDICAID