Provider Demographics
NPI:1578451233
Name:REIL, BROOKELYN KAY (AUD)
Entity type:Individual
Prefix:
First Name:BROOKELYN
Middle Name:KAY
Last Name:REIL
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 1:1531 S GREEN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2130
Mailing Address - Country:US
Mailing Address - Phone:702-245-9531
Mailing Address - Fax:
Practice Address - Street 1:3945 WASHINGTON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1988
Practice Address - Country:US
Practice Address - Phone:801-479-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14228809-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist