Provider Demographics
NPI:1871570481
Name:MAXWELL, ERIC L (AUD, FAAA)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:L
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:AUD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 N MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-7744
Mailing Address - Country:US
Mailing Address - Phone:435-867-0714
Mailing Address - Fax:435-867-0739
Practice Address - Street 1:1870 N MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-7744
Practice Address - Country:US
Practice Address - Phone:435-867-0714
Practice Address - Fax:435-867-0739
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5256571-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT73269OtherPEHP
UT813571OtherDMBA
UT230742OtherSELECT HEATH
UT52565714100001OtherBLUE CROSS BLUE SHIELD
UT005732001Medicare PIN
UT230742OtherSELECT HEATH