Provider Demographics
NPI:1710583935
Name:LARSEN HEARING AND ACOUSTICS
Entity Type:Organization
Organization Name:LARSEN HEARING AND ACOUSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:B
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-A
Authorized Official - Phone:801-417-9696
Mailing Address - Street 1:2964 W 4700 S STE 116
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-2559
Mailing Address - Country:US
Mailing Address - Phone:801-417-9696
Mailing Address - Fax:801-417-9697
Practice Address - Street 1:2964 W 4700 S STE 116
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-2559
Practice Address - Country:US
Practice Address - Phone:801-417-9696
Practice Address - Fax:801-417-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty