Provider Demographics
NPI:1972806651
Name:NORMAN, LEANNE M (AUD)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:M
Last Name:NORMAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:M
Other - Last Name:FELLBAUM-NORMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:6165 W PINE VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84118-9340
Mailing Address - Country:US
Mailing Address - Phone:801-712-9123
Mailing Address - Fax:
Practice Address - Street 1:6165 W PINE VALLEY LN
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84118-9340
Practice Address - Country:US
Practice Address - Phone:801-712-9123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT372790-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTPP1066378OtherRAIL ROAD MEDICARE