Provider Demographics
NPI:1306156849
Name:HAM, ADRIENNE CATARINA (MA, SLP)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:CATARINA
Last Name:HAM
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:MS
Other - First Name:ADRIENNE
Other - Middle Name:CATARINA
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, SLP
Mailing Address - Street 1:756 E 12200 S
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9724
Mailing Address - Country:US
Mailing Address - Phone:801-328-2522
Mailing Address - Fax:801-924-2900
Practice Address - Street 1:756 E 12200 S
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9724
Practice Address - Country:US
Practice Address - Phone:801-328-2522
Practice Address - Fax:801-924-2900
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18594235Z00000X
UT8052271-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist