Provider Demographics
NPI:1790029023
Name:LARKIN, SHANE
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:LARKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 WOODLAND PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5635
Mailing Address - Country:US
Mailing Address - Phone:801-525-5254
Mailing Address - Fax:801-525-2016
Practice Address - Street 1:1528 WOODLAND PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5635
Practice Address - Country:US
Practice Address - Phone:801-525-5254
Practice Address - Fax:801-525-2016
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6238741-4601237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist