Healthcare Provider Details

I. General information

NPI: 1619239092
Provider Name (Legal Business Name): KENNINGTON HEARING & BALANCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2012
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: 801-643-7088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: MR. KODY D KENNINGTON
Title or Position: DR. OF AUDIOLOGY
Credential: AU.D.
Phone: 801-643-7088