Basic Information
| Provider Information | |||||||||
| NPI: | 1346986957 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | NOEL | ||||||||
| MiddleName: | RUBY | ||||||||
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| Credential: | MNS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3641 W WHITEWOOD CIR | ||||||||
| Address2: | |||||||||
| City: | TAYLORSVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841293616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019679687 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 S STATE ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH SALT LAKE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841153164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3856465000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2022 | ||||||||
| LastUpdateDate: | 05/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 566769 | UT | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.