Healthcare Provider Details

I. General information

NPI: 1609508530
Provider Name (Legal Business Name): ANNA BERKELEY THOMAS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 E 5900 S STE A107
MURRAY UT
84107-7361
US

IV. Provider business mailing address

2191 S PRESTON ST
SALT LAKE CITY UT
84106-4110
US

V. Phone/Fax

Practice location:
  • Phone: 801-843-6113
  • Fax: 801-843-6114
Mailing address:
  • Phone: 717-462-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number12855085-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: