Individual
KAYLIE A LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
230 W 200 S # 142, SALT LAKE CITY, UT 84101-1337
(801) 433-2595
Mailing address
230 W 200 S # 142, SALT LAKE CITY, UT 84101-1337
(801) 433-2595
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336336445
—
UT
Enumeration date
10/21/2020
Last updated
10/21/2020
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