MEDICARE: MS. KERSTIN M ANDERSON AUDIOLOGIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	55646794101	UT
2	231H00000X	Audiologist	5564679-4101	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55646794101	OTHER	UT	UTAH STATE LICENSE

General Provider Information

NPI Number	:	1730102542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KERSTIN M ANDERSON AUDIOLOGIST

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 W COUGAR BLVD STE 501
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-3323
Country	:	US
Telephone Number	:	801-357-4945
Fax Number	:	801-357-7527

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	04/06/2026

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