Provider Demographics
NPI:1396877247
Name:WALKER, MICHAEL T (AUD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:WALKER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:T
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:9980 S 300 W STE 200
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3654
Mailing Address - Country:US
Mailing Address - Phone:801-718-2682
Mailing Address - Fax:801-285-7401
Practice Address - Street 1:9980 S 300 W STE 200
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070
Practice Address - Country:US
Practice Address - Phone:801-718-2682
Practice Address - Fax:801-285-7401
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT110475-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1692Medicare ID - Type Unspecified