Basic Information
| Provider Information | |||||||||
| NPI: | 1417961285 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIRCH | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27128 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841270128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015358163 | ||||||||
| FaxNumber: | 8013554011 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 S 900 E | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841022310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015358163 | ||||||||
| FaxNumber: | 8013554011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 09/26/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 953111034101 | UT | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.