Provider Demographics
NPI:1396446654
Name:THOMSEN, KIERA LYN (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KIERA
Middle Name:LYN
Last Name:THOMSEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 S 1080 W
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6527
Mailing Address - Country:US
Mailing Address - Phone:435-881-3972
Mailing Address - Fax:
Practice Address - Street 1:2912 S 1080 W
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6527
Practice Address - Country:US
Practice Address - Phone:435-881-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT437214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist