Provider Demographics
NPI:1609508530
Name:THOMAS, ANNA BERKELEY (AUD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:BERKELEY
Last Name:THOMAS
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 1:2191 S PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4110
Mailing Address - Country:US
Mailing Address - Phone:717-462-3446
Mailing Address - Fax:
Practice Address - Street 1:164 E 5900 S STE A107
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7361
Practice Address - Country:US
Practice Address - Phone:801-843-6113
Practice Address - Fax:801-843-6114
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12855085-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist