Provider Demographics
NPI:1841322161
Name:DEMILL, TROY B
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:B
Last Name:DEMILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3208
Mailing Address - Country:US
Mailing Address - Phone:801-464-7660
Mailing Address - Fax:801-464-7558
Practice Address - Street 1:2000 S 900 E
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84105-3208
Practice Address - Country:US
Practice Address - Phone:801-464-7660
Practice Address - Fax:801-464-7558
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT291942-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTR96410Medicare UPIN
UT005539398Medicare PIN