Provider Demographics
NPI:1295461176
Name:HURTADO, GENOVEVA (AUD)
Entity type:Individual
Prefix:
First Name:GENOVEVA
Middle Name:
Last Name:HURTADO
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 1:206 S INDIAN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-4306
Mailing Address - Country:US
Mailing Address - Phone:575-643-5285
Mailing Address - Fax:
Practice Address - Street 1:5872 S 900 E STE 175
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1673
Practice Address - Country:US
Practice Address - Phone:801-268-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12855266-4101231H00000X
SC4239231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist