Provider Demographics
NPI:1760724181
Name:STEVENS, CAROLYN (LMT, BSC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LMT, BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 E REDONDO AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-3119
Mailing Address - Country:US
Mailing Address - Phone:435-655-1703
Mailing Address - Fax:
Practice Address - Street 1:1961 E REDONDO AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-3119
Practice Address - Country:US
Practice Address - Phone:435-655-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-24
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6789138-4701225700000X, 225700000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Yes171400000XOther Service ProvidersHealth & Wellness Coach