Provider Demographics
NPI:1437680592
Name:SIMMONS, DAVID (MED, BC-HIS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:MED, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10852 S MARSHA KAYE CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5277
Mailing Address - Country:US
Mailing Address - Phone:801-523-8899
Mailing Address - Fax:
Practice Address - Street 1:10852 S MARSHA KAYE CIR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5277
Practice Address - Country:US
Practice Address - Phone:801-523-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101299-4601237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist