Provider Demographics
NPI:1063224533
Name:MANSFIELD, DYLAN (HIS-INTERN)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:MANSFIELD
Suffix:
Gender:M
Credentials:HIS-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2156 N HILL FIELD RD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4771
Mailing Address - Country:US
Mailing Address - Phone:801-203-4055
Mailing Address - Fax:
Practice Address - Street 1:150 N MAIN ST STE 108
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1671
Practice Address - Country:US
Practice Address - Phone:801-203-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13970332-4602237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist