Provider Demographics
NPI:1730925546
Name:JOHNSON, KYLIE RICH (AUD)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:RICH
Last Name:JOHNSON
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 1:2250 N MILLER CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7233
Mailing Address - Country:US
Mailing Address - Phone:385-531-1000
Mailing Address - Fax:
Practice Address - Street 1:2250 N MILLER CAMPUS DR
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-7233
Practice Address - Country:US
Practice Address - Phone:385-531-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13975332-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist