Healthcare Provider Details

I. General information

NPI: 1205752805
Provider Name (Legal Business Name): KATELYN TAYLOR EARNEST CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7733 S REDWOOD RD
WEST JORDAN UT
84084-5518
US

IV. Provider business mailing address

301 INDIAN CAMP RD
OGDEN UT
84404-4738
US

V. Phone/Fax

Practice location:
  • Phone: 801-885-1700
  • Fax:
Mailing address:
  • Phone: 303-884-9107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14241586-4102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: