Active NPI
Jen Statham
- Speech-Language Pathologist
- St George, UT
National Provider Identifier
1740143742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 12201342-4102
- Practice address
- 5647 S Carnelian Pkwy
St George, UT 84790-2374 - Phone
- (435) 900-1399
- NPI assigned
- Dec 5, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 12201342-4102 | UT | Primary |
Addresses
Primary practice location
5647 S Carnelian Pkwy
St George, UT 84790-2374
Mailing address
1991 E Knolls Dr
St George, UT 84790-6289
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12201342-4102 | UT | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1764892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1764892800000",
"number": "1740143742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1991 E KNOLLS DR",
"city": "ST GEORGE",
"state": "UT",
"postal_code": "847906289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5647 S CARNELIAN PKWY",
"city": "ST GEORGE",
"state": "UT",
"postal_code": "847902374",
"telephone_number": "435-900-1399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STATHAM",
"first_name": "JEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-12-05",
"last_updated": "2025-12-05",
"certification_date": "2025-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": "UT",
"license": "12201342-4102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St George, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.