Healthcare Provider Details

I. General information

NPI: 1336224906
Provider Name (Legal Business Name): CAROLINE CLARK BJARNASON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N 1075 W SUITE 230
FARMINGTON UT
84025-2745
US

IV. Provider business mailing address

1401 N 1075 W SUITE 230
FARMINGTON UT
84025-2745
US

V. Phone/Fax

Practice location:
  • Phone: 801-447-9456
  • Fax: 801-447-9458
Mailing address:
  • Phone: 801-447-9456
  • Fax: 801-447-9458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU2407
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA6081
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5542067-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: