Provider Demographics
NPI:1194780783
Name:ANDERSEN, ALLAN L (MS)
Entity type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:L
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9690 S 1300 E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3721
Mailing Address - Country:US
Mailing Address - Phone:801-501-4305
Mailing Address - Fax:801-501-4308
Practice Address - Street 1:9690 S 1300 E
Practice Address - Street 2:SUITE 200
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3721
Practice Address - Country:US
Practice Address - Phone:801-501-4305
Practice Address - Fax:801-501-4308
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1048354101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000004222Medicare ID - Type Unspecified