Provider Demographics
NPI:1922622463
Name:DODSWORTH, TANEIL C (AUD)
Entity Type:Individual
Prefix:
First Name:TANEIL
Middle Name:C
Last Name:DODSWORTH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5872 S 900 E STE 175
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1673
Mailing Address - Country:US
Mailing Address - Phone:801-268-3277
Mailing Address - Fax:801-268-3288
Practice Address - Street 1:5872 S 900 E STE 175
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1673
Practice Address - Country:US
Practice Address - Phone:801-268-3277
Practice Address - Fax:801-268-3288
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11788278-4101237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter