Healthcare Provider Details

I. General information

NPI: 1194076752
Provider Name (Legal Business Name): AUDIOLOGY PROFESSIONALS LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 ADAMS AVE PKWY STE B
OGDEN UT
84405-6748
US

IV. Provider business mailing address

5275 ADAMS AVE PKWY STE B
OGDEN UT
84405-6748
US

V. Phone/Fax

Practice location:
  • Phone: 801-394-4399
  • Fax: 801-394-5003
Mailing address:
  • Phone: 801-394-4399
  • Fax: 801-394-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: LISA CHRISTENSEN
Title or Position: OWNER
Credential:
Phone: 801-394-4399