Basic Information
| Provider Information | |||||||||
| NPI: | 1922500933 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAMBERLAIN | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | LYNNE | ||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | GIBSON | ||||||||
| OtherFirstName: | LAURIE | ||||||||
| OtherMiddleName: | LYNNE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 206 N 2100 W | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841164740 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 350 E 300 N | ||||||||
| Address2: | |||||||||
| City: | AMERICAN FORK | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840031717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017565293 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2018 | ||||||||
| LastUpdateDate: | 03/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 10179115-4104 | UT | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.