Provider Demographics
NPI:1255174744
Name:REDFORD, RACHAEL KRISTINE (AUD)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:KRISTINE
Last Name:REDFORD
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 1:797 DAVID WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-1541
Mailing Address - Country:US
Mailing Address - Phone:805-801-4649
Mailing Address - Fax:
Practice Address - Street 1:140 W 2100 S STE 120
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-1855
Practice Address - Country:US
Practice Address - Phone:801-484-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5182000-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist