Healthcare Provider Details

I. General information

NPI: 1457819435
Provider Name (Legal Business Name): MINDY JEAN BESS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3556 W 9800 S STE 102
SOUTH JORDAN UT
84095-3225
US

IV. Provider business mailing address

10073 S COPPER KING LN
SOUTH JORDAN UT
84095-2477
US

V. Phone/Fax

Practice location:
  • Phone: 801-440-9899
  • Fax:
Mailing address:
  • Phone: 801-633-8352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number10694501-4101
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number10694501-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: