MEDICARE: ANNA BERKELEY THOMAS AUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	12855085-4101	UT

General Provider Information

NPI Number	:	1609508530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA BERKELEY THOMAS AUD

Provider Business Mailing Address
First Line	:	2191 S PRESTON ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-4110
Country	:	US
Telephone Number	:	717-462-3446
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 E 5900 S STE A107
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-7361
Country	:	US
Telephone Number	:	801-843-6113
Fax Number	:	801-843-6114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2022
Last Update Date	:	09/18/2024

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Directions to “ ANNA BERKELEY THOMAS AUD” Practice Location

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