Provider Demographics
NPI:1720716079
Name:VANCE, JUSTIN SCOTT (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:SCOTT
Last Name:VANCE
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 N 100 E
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-1758
Mailing Address - Country:US
Mailing Address - Phone:801-610-8400
Mailing Address - Fax:
Practice Address - Street 1:575 N 100 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-1758
Practice Address - Country:US
Practice Address - Phone:801-610-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8844157-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist