Basic Information
Provider Information
NPI: 1003139742
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PENDLETON
FirstName: NORWOOD
MiddleName: E.
NamePrefix: MR.
NameSuffix:  
Credential: NBC-HIS MS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HEBDON
OtherFirstName: TRENT
OtherMiddleName:  
OtherNamePrefix: MR.
OtherNameSuffix:  
OtherCredential: NBA-HIS-BS
OtherLastNameType: 2
Mailing Information
Address1: 1410 N HILL FIELD RD STE 5
Address2:  
City: LAYTON
State: UT
PostalCode: 840415056
CountryCode: US
TelephoneNumber: 8016686479
FaxNumber: 8013174076
Practice Location
Address1: 1410 N HILL FIELD RD STE 5
Address2:  
City: LAYTON
State: UT
PostalCode: 840415056
CountryCode: US
TelephoneNumber: 8016686479
FaxNumber: 8013174076
Other Information
ProviderEnumerationDate: 03/09/2010
LastUpdateDate: 03/09/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
237700000X1061044601UTY Speech, Language and Hearing Service ProvidersHearing Instrument Specialist 

No ID Information.


Home