Provider Demographics
NPI:1619239092
Name:KENNINGTON HEARING & BALANCE CENTER
Entity Type:Organization
Organization Name:KENNINGTON HEARING & BALANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. OF AUDIOLOGY
Authorized Official - Prefix:MR
Authorized Official - First Name:KODY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:801-643-7088
Mailing Address - Street 1:985 W 7850 S
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:UT
Mailing Address - Zip Code:84340-6701
Mailing Address - Country:US
Mailing Address - Phone:801-643-7088
Mailing Address - Fax:
Practice Address - Street 1:1100 COUNTRY HILLS DR
Practice Address - Street 2:200
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2503
Practice Address - Country:US
Practice Address - Phone:801-399-5014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1982840716Medicaid
UT1982840716Medicaid