Provider Demographics
NPI:1396344495
Name:BOAL, BRENDA SAHR (MS, BC-HIS)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:SAHR
Last Name:BOAL
Suffix:
Gender:F
Credentials:MS, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3344 E FORTUNA DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-5616
Mailing Address - Country:US
Mailing Address - Phone:143-571-4171
Mailing Address - Fax:
Practice Address - Street 1:1055 W HILL FIELD RD
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4614
Practice Address - Country:US
Practice Address - Phone:801-315-9504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10990074-4601237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty