Provider Demographics
NPI:1144929126
Name:HAMBERLIN, JALIZABETH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JALIZABETH
Middle Name:
Last Name:HAMBERLIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1574 E 1300 N
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-9758
Mailing Address - Country:US
Mailing Address - Phone:435-201-1762
Mailing Address - Fax:
Practice Address - Street 1:1574 E 1300 N
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-9758
Practice Address - Country:US
Practice Address - Phone:435-201-1762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT437077OtherSTATE OF UTAH PROFESSIONAL EDUCATORS LICENSE