Healthcare Provider Details

I. General information

NPI: 1124301965
Provider Name (Legal Business Name): AUSTIN JACK SINGLETON AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9071 S 1300 W STE 100
WEST JORDAN UT
84088-6672
US

IV. Provider business mailing address

9071 S 1300 W STE 100
WEST JORDAN UT
84088-6672
US

V. Phone/Fax

Practice location:
  • Phone: 801-938-1928
  • Fax: 866-961-3161
Mailing address:
  • Phone: 801-938-1928
  • Fax: 866-961-3161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147001406
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number8106522-4101
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number80442
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4168
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: