Provider Demographics
NPI:1215170337
Name:MOODY, CAROL PAULSON (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:PAULSON
Last Name:MOODY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 E 1200 S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6904
Mailing Address - Country:US
Mailing Address - Phone:801-224-3014
Mailing Address - Fax:801-224-4914
Practice Address - Street 1:361 E 1200 S
Practice Address - Street 2:SUITE 201
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6904
Practice Address - Country:US
Practice Address - Phone:801-224-3014
Practice Address - Fax:801-224-4914
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2145454102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty