Provider Demographics
NPI:1689744138
Name:NIELSEN, KENT J (AUD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:J
Last Name:NIELSEN
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 1:70 S FAIRFIELD RD STE 10
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4495
Mailing Address - Country:US
Mailing Address - Phone:801-294-6200
Mailing Address - Fax:801-497-9301
Practice Address - Street 1:3651 WALL AVE
Practice Address - Street 2:NEWGATE MALL
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-2014
Practice Address - Country:US
Practice Address - Phone:801-612-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108649-4101237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10864941003001OtherBLUE CROSS BLUE SHIELD
UT80601OtherPEHP
UTPRO7581OtherMOLINA
UT1689744138Medicaid
UT10864941004001OtherBLUE CROSS BLUE SHIELD
UT224962OtherALTIUS
UT10864941006001OtherBLUE CROSS BLUE SHIELD
UT005739602Medicare PIN
UT10864941004001OtherBLUE CROSS BLUE SHIELD