Healthcare Provider Details

I. General information

NPI: 1689744138
Provider Name (Legal Business Name): KENT J NIELSEN AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 WALL AVE NEWGATE MALL
OGDEN UT
84405-2014
US

IV. Provider business mailing address

70 S FAIRFIELD RD STE 10
LAYTON UT
84041-4495
US

V. Phone/Fax

Practice location:
  • Phone: 801-612-0202
  • Fax:
Mailing address:
  • Phone: 801-294-6200
  • Fax: 801-497-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number108649-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: