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NPI Code Detail

MEDICARE: SPENCER TIETJEN AU.D.

MEDICARE: SPENCER TIETJEN AU.D.
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
1231H00000XAudiologist

General Provider Information

NPI Number : 1851699003
Entity Type Code : Individual
Provider Name (Legal Business Name) : SPENCER TIETJEN AU.D.
Provider Business Mailing Address
First Line : 2245 N 400 E
Second Line : STE 301
City : LOGAN
State : UT
Zip : 84341-1892
Country : US
Telephone Number : 435-753-7880
Fax Number :
Provider Business Practice Location Address
First Line : 2245 N 400 E
Second Line : STE 301
City : LOGAN
State : UT
Zip : 84341-1892
Country : US
Telephone Number : 435-753-7880
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2011
Last Update Date : 06/24/2022

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Directions to “ SPENCER TIETJEN AU.D.” Practice Location

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