Healthcare Provider Details

I. General information

NPI: 1649365198
Provider Name (Legal Business Name): MINDY DAWN ANDERSON SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MINDY DAWN LARSEN SLP

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 N HILLCREST DR
ROOSEVELT UT
84066-2217
US

IV. Provider business mailing address

490 N HILLCREST DR
ROOSEVELT UT
84066-2217
US

V. Phone/Fax

Practice location:
  • Phone: 435-828-8706
  • Fax:
Mailing address:
  • Phone: 435-828-8706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5138975-4102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: