Provider Demographics
NPI:1114793981
Name:WORKMAN, KARLEE LARSEN (MA, SLP-CCC)
Entity type:Individual
Prefix:
First Name:KARLEE
Middle Name:LARSEN
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:MA, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N 200 E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-3316
Mailing Address - Country:US
Mailing Address - Phone:801-367-8049
Mailing Address - Fax:
Practice Address - Street 1:730 N 200 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-3316
Practice Address - Country:US
Practice Address - Phone:801-367-8049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13099313-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty