Basic Information
| Provider Information | |||||||||
| NPI: | 1386092450 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCKINNON | ||||||||
| FirstName: | RYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5270 S ROME BEAUTY PARK | ||||||||
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| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841234504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3852329234 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9361 S 300 E | ||||||||
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| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840702902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018265000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2016 | ||||||||
| LastUpdateDate: | 05/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 12178095-4102 | UT | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 246Z00000X | N | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other |
No ID Information.