Healthcare Provider Details

I. General information

NPI: 1154632123
Provider Name (Legal Business Name): ALAN YOUNG AUDIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5642 SOUTH 900 EAST SUITE #1
SALT LAKE CITY UT
84121-1066
US

IV. Provider business mailing address

5642 SOUTH 900 EAST SUITE #1
SALT LAKE CITY UT
84121-1066
US

V. Phone/Fax

Practice location:
  • Phone: 801-713-0101
  • Fax: 801-262-1091
Mailing address:
  • Phone: 801-713-0101
  • Fax: 801-262-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number348193-4101
License Number StateUT

VIII. Authorized Official

Name: MS. SHARRON KAYE KIMBALL
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 801-713-0101