Healthcare Provider Details

I. General information

NPI: 1942149554
Provider Name (Legal Business Name): MAKYNZIE LARSEN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 OLD MAIN HILL
LOGAN UT
84322-6405
US

IV. Provider business mailing address

6405 OLD MAIN HILL
LOGAN UT
84322-6405
US

V. Phone/Fax

Practice location:
  • Phone: 435-797-4200
  • Fax: 844-308-5865
Mailing address:
  • Phone: 435-797-4200
  • Fax: 844-308-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number13035145-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: