Basic Information
| Provider Information | |||||||||
| NPI: | 1023210770 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OGDEN SPEECH AND HEARING CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 978 CHAMBERS ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SOUTH OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844034861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013995601 | ||||||||
| FaxNumber: | 8013942230 | ||||||||
| Practice Location | |||||||||
| Address1: | 978 CHAMBERS ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SOUTH OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844034861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013995601 | ||||||||
| FaxNumber: | 8013942230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 11/25/2015 | ||||||||
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| AuthorizedOfficialLastName: | BOMAN | ||||||||
| AuthorizedOfficialFirstName: | TEL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | AUDIOLOGIST PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8013995601 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 106698-4101 | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.