Healthcare Provider Details

I. General information

NPI: 1578451233
Provider Name (Legal Business Name): BROOKELYN KAY REIL AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 WASHINGTON BLVD STE 1
OGDEN UT
84403-1988
US

IV. Provider business mailing address

1531 S GREEN ST APT 1
SALT LAKE CITY UT
84105-2130
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-4105
  • Fax:
Mailing address:
  • Phone: 702-245-9531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number14228809-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: