Basic Information
| Provider Information | |||||||||
| NPI: | 1043484223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEAMONS | ||||||||
| FirstName: | CARLA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2380 N 400 E STE D | ||||||||
| Address2: | |||||||||
| City: | NORTH LOGAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843411756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357537880 | ||||||||
| FaxNumber: | 4357535845 | ||||||||
| Practice Location | |||||||||
| Address1: | 2380 N 400 E STE D | ||||||||
| Address2: | |||||||||
| City: | NORTH LOGAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843411756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357537880 | ||||||||
| FaxNumber: | 4357535845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2008 | ||||||||
| LastUpdateDate: | 04/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 111339-4101 | UT | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 111339-4101 | 01 | UT | STATE LICENSE | OTHER | 01070999 | 01 | UT | AMER. SPEECH/ HEARING AS. | OTHER |