Basic Information
| Provider Information | |||||||||
| NPI: | 1275917775 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORALES | ||||||||
| FirstName: | JENNY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95970 | ||||||||
| Address2: | |||||||||
| City: | SOUTH JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840950970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013529500 | ||||||||
| FaxNumber: | 8013529502 | ||||||||
| Practice Location | |||||||||
| Address1: | 1477 N 2000 W | ||||||||
| Address2: | SUITE E | ||||||||
| City: | CLINTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840158638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016145866 | ||||||||
| FaxNumber: | 8018251162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2015 | ||||||||
| LastUpdateDate: | 07/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | UT | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.