Healthcare Provider Details

I. General information

NPI: 1518885797
Provider Name (Legal Business Name): BRYCE WETLAUFER AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 RIVERDALE RD
RIVERDALE UT
84405-1517
US

IV. Provider business mailing address

5303 50TH ST
LUBBOCK TX
79414-1817
US

V. Phone/Fax

Practice location:
  • Phone: 806-702-8208
  • Fax: 806-785-4327
Mailing address:
  • Phone: 806-702-8208
  • Fax: 806-785-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number14292965-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: