Provider Demographics
NPI:1154537538
Name:TANNER, KRISTINE MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:MARIE
Last Name:TANNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10287 CALLA LILY WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4374
Mailing Address - Country:US
Mailing Address - Phone:801-587-3548
Mailing Address - Fax:
Practice Address - Street 1:729 ARAPEEN DR
Practice Address - Street 2:CAMT BUILDING, VOICE DISORDERS CENTER
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1218
Practice Address - Country:US
Practice Address - Phone:801-587-3548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT47913364102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist