Healthcare Provider Details

I. General information

NPI: 1770716979
Provider Name (Legal Business Name): JORDAN HEARING AND BALANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10588 S REDWOOD RD
SOUTH JORDAN UT
84095-8503
US

IV. Provider business mailing address

10588 S REDWOOD RD
SOUTH JORDAN UT
84095-8503
US

V. Phone/Fax

Practice location:
  • Phone: 801-344-9495
  • Fax:
Mailing address:
  • Phone: 801-344-9495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: LYNN STEPHEN ALVORD
Title or Position: OWNER
Credential: PHD
Phone: 801-344-9495