Provider Demographics
NPI:1487489654
Name:ANDERSON, RYAN K (AUD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 W 1080 S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-3003
Mailing Address - Country:US
Mailing Address - Phone:435-893-5858
Mailing Address - Fax:
Practice Address - Street 1:1000 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2069
Practice Address - Country:US
Practice Address - Phone:435-893-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13975229-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist