Basic Information
| Provider Information | |||||||||
| NPI: | 1972531028 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOMAN | ||||||||
| FirstName: | TEL | ||||||||
| MiddleName: | SKIDMORE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S., AUD | ||||||||
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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: | 06/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 237600000X | 106698-4101 | UT | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.