Provider Demographics
NPI:1922034883
Name:CURTIS, KENNETH MARTIN (AUD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MARTIN
Last Name:CURTIS
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 1:685 W 2475 S
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-7618
Mailing Address - Country:US
Mailing Address - Phone:435-770-4475
Mailing Address - Fax:
Practice Address - Street 1:16494 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7865
Practice Address - Country:US
Practice Address - Phone:714-843-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT290854-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist