Jackie Larsen

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

115154024102 Issued in UT

Practice address

1211 S 1530 W
Springville, UT 84663-5074

Phone

(562) 841-2877

NPI assigned

Jul 12, 2023

Last updated

Jul 12, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

University of Hawaii John a. Burns School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Live Well Speech Therapy LLC

  • Speech-Language Pathologist
  • Springville, UT
  • NPI 1952080475
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1659050177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 S 1530 W",
            "city": "SPRINGVILLE",
            "state": "UT",
            "postal_code": "846635074",
            "telephone_number": "562-841-2877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 S 1530 W",
            "city": "SPRINGVILLE",
            "state": "UT",
            "postal_code": "846635074",
            "telephone_number": "562-841-2877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "JACKIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-12",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "UT",
            "license": "115154024102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Kunzler, PHARMD
• Makenzi Elise Kygar, RN
• Kelli Ladig
• Brian B Lambert, PT
• Nanilia Lara, LMT
• Korey Kevin Larsen, LCSW
• Nancy Rodriguez Larsen, MSW, LCSW
• Latter Day Saints Family Services
• Carolyn G. Laturner
• LDS Family Services (LDS Family Services UT Springville)

• Speech-Language Pathologist in Springville, UT
• Providers in Springville, UT by specialty
• Speech-Language Pathologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.