Provider Demographics
NPI:1598881328
Name:ELIASON, KIERSTIN SANDBERG (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KIERSTIN
Middle Name:SANDBERG
Last Name:ELIASON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KIERSTIN
Other - Middle Name:
Other - Last Name:SANDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:145 W 1600 N
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-1158
Mailing Address - Country:US
Mailing Address - Phone:018-557-5067
Mailing Address - Fax:
Practice Address - Street 1:70 E 100 N
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3531
Practice Address - Country:US
Practice Address - Phone:801-402-1309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4917310-4102235Z00000X
UT491731-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist