Provider Demographics
NPI:1063438620
Name:WASATCH SPEECH & LANGUAGE CENTER
Entity type:Organization
Organization Name:WASATCH SPEECH & LANGUAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GURRISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC
Authorized Official - Phone:801-308-0400
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-0307
Mailing Address - Country:US
Mailing Address - Phone:888-700-6907
Mailing Address - Fax:801-294-6917
Practice Address - Street 1:2120 E 3900 S
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84124-1771
Practice Address - Country:US
Practice Address - Phone:801-308-0400
Practice Address - Fax:801-308-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT110090-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty