Healthcare Provider Details

I. General information

NPI: 1982957817
Provider Name (Legal Business Name): SPENCER K LIFFERTH AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date: 01/22/2019
Reactivation Date: 02/25/2019

III. Provider practice location address

755 W ANTELOPE DR
LAYTON UT
84041-1630
US

IV. Provider business mailing address

5349 S ADAMS AVE PKWY SUITE C
OGDEN UT
84405
US

V. Phone/Fax

Practice location:
  • Phone: 385-383-7162
  • Fax: 385-383-7113
Mailing address:
  • Phone: 801-479-3346
  • Fax: 801-479-0725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number97419074101
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA-1086
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number97419074101
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-1086
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: