Healthcare Provider Details

I. General information

NPI: 1922575414
Provider Name (Legal Business Name): KATHARINE G EMERSON CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHARINE G TERPSTRA CCC-SLP

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 E 3900 S
MILLCREEK UT
84107-1973
US

IV. Provider business mailing address

670 E 3900 S
MILLCREEK UT
84107-1973
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-3979
  • Fax:
Mailing address:
  • Phone: 801-266-3979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number119732
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13327376-4102
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-69508
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: