Healthcare Provider Details

I. General information

NPI: 1396518239
Provider Name (Legal Business Name): CHELSEY LARSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 10/26/2024
Certification Date: 10/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 N ROBINS DR
LAYTON UT
84041-1140
US

IV. Provider business mailing address

934 S MAIN ST
LAYTON UT
84041-7135
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-7060
  • Fax:
Mailing address:
  • Phone: 801-773-7060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: