Healthcare Provider Details

I. General information

NPI: 1982840716
Provider Name (Legal Business Name): KODY D KENNINGTON AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 COUNTRY HILLS DR 200
OGDEN UT
84403-2503
US

IV. Provider business mailing address

985 W 7850 S
WILLARD UT
84340-6701
US

V. Phone/Fax

Practice location:
  • Phone: 801-399-5014
  • Fax:
Mailing address:
  • Phone: 435-734-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5159751-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: