Healthcare Provider Details

I. General information

NPI: 1285565507
Provider Name (Legal Business Name): KYLEE THAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2834 S 1900 W
OGDEN UT
84401
US

IV. Provider business mailing address

PO BOX 295
MONA UT
84645-0295
US

V. Phone/Fax

Practice location:
  • Phone: 801-608-8056
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14236774-4104
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: