Provider Demographics
NPI:1013263573
Name:IOM PROFESSIONALS
Entity type:Organization
Organization Name:IOM PROFESSIONALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-688-8991
Mailing Address - Street 1:1054 E RIVERSIDE DR
Mailing Address - Street 2:STE 201
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4825
Mailing Address - Country:US
Mailing Address - Phone:435-688-8991
Mailing Address - Fax:435-688-2122
Practice Address - Street 1:1054 E RIVERSIDE DR
Practice Address - Street 2:STE 201
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4825
Practice Address - Country:US
Practice Address - Phone:435-688-8991
Practice Address - Fax:435-688-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5935522-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty