DR. JEFFERY BLYTHE LARSEN (NPI# 1033441308) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033441308 |
| Entity Type | Individual |
| Full Name | DR. JEFFERY BLYTHE LARSEN |
| Credential | PH.D., CCC-A |
| Practice Address |
1000 Old Main Hl Comd Department, Umc 1000 Logan UT 84322-1000 |
| Mailing Address |
6410 Old Main Hl Logan UT 84322-6410 |
| Practice Telephone | 4357971390 |
| Mailing Telephone | 4357971373 |
| Mailing Fax Number | 8443085865 |
| Enumeration Date | 2010-02-11 |
| Last Update Date | 2018-11-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 231H00000X | Audiologist | 6207896-4101 | UT | Speech, Language and Hearing Service Providers |
| Street Address |
1000 OLD MAIN HL COMD DEPARTMENT, UMC 1000 |
| City | LOGAN |
| State | UT |
| Zip Code | 84322-1000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871509356 | Cache Laurence Pitt | Audiologist | 1000 Old Main Hl, Logan, UT 84322-1000 | 2006-08-01 |
| 1932625985 | Kendra Lee Schofield | Speech-Language Pathologist | 1000 Old Main Hl, Logan, UT 84322-1000 | 2017-08-21 |
| 1134675341 | Leigh Stott | Speech-Language Pathologist | 1000 Old Main Hl, Logan, UT 84322-1000 | 2016-08-28 |
| 1447629035 | Abish Sanderson | Speech-Language Pathologist | 1000 Old Main Hl, Logan, UT 84322-1000 | 2015-09-24 |
| 1689059982 | Nicole Martin | Speech-Language Pathologist | 1000 Old Main Hl, Logan, UT 84322-1000 | 2015-07-28 |
| 1568847861 | Jeanette Smoot | Speech-Language Pathologist | 1000 Old Main Hl, Logan, UT 84322-1000 | 2015-07-28 |
| 1073998365 | Tiffany Shelton | Audiologist | 1000 Old Main Hl, Logan, UT 84322-1000 | 2015-07-28 |
| 1295110591 | Marjorie Edwards | Speech-Language Pathologist | 1000 Old Main Hl, Logan, UT 84322-1000 | 2015-07-28 |
| 1497198592 | Jill R. Andrus | Speech-Language Pathologist | 1000 Old Main Hl, Logan, UT 84322-1000 | 2013-04-09 |
| 1558600304 | Deborah Dawson Evans | Speech-Language Pathologist | 1000 Old Main Hl, Usu, Logan, UT 84322-1000 | 2013-02-13 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447706007 | Conner Andrews | Physician Assistant | 7425 Old Main Hill, Logan, UT 84322 | 2016-09-01 |
| 1841743515 | Kali Leanne Markle | Audiologist | 2620 Old Main Hl, Logan, UT 84322 | 2016-07-29 |
| 1043670011 | Paul Bryan Beachem Iv | Specialist/Technologist | 7400 Old Main Hill, Dale Mildenberger Sports Medicine Complex, Logan, UT 84322 | 2016-03-03 |
| 1508387176 | Matthew Steven Buckner | Specialist/Technologist | 7400 Old Main Hl, Logan, UT 84322 | 2017-07-04 |
| 1386776730 | Utah State University | Psychologist | 2810 Old Main Hl, Logan, UT 84322 | 2007-03-12 |
| 1366971368 | Caleigh Goode | Specialist/Technologist | 7425 Old Main Hill Athletic Training Room, Logan, UT 84322-0001 | 2017-06-05 |
| 1639319775 | Vicki L. Simonsmeier | Speech-Language Pathologist | Department of Communicative Disorders, 1000 Old Main Hill, Logan, UT 84322-0001 | 2009-03-03 |
| 1730246299 | George Christopher Wootton | Nurse Practitioner | 6802 Old Main Hl, Utah State University, Logan, UT 84322-0001 | 2007-01-03 |
| 1356373807 | Utah State University, Center for Persons With Disabilities | Day Training, Developmentally Disabled Services | 6810 Old Main Hl, Logan, UT 84322-0001 | 2006-07-07 |
| 1801878095 | James Walter Davis | Emergency Medicine | 9100 Old Main Hill, 850 East 1200 North, Logan, UT 84322-0001 | 2005-11-15 |
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| Taxonomy Code | 231H00000X |
| Grouping | Speech, Language and Hearing Service Providers |
| Classification | Audiologist |
| (1) A specialist in evaluation, habilitation and rehabilitation of those whose communication disorders center in whole or in part in hearing function. Audiologists are autonomous professionals who identify, assess, and manage disorders of the auditory, balance and other neural systems. Audiologists provide audiological (aural) rehabilitation to children and adults across the entire age span. Audiologists select, fit and dispense amplification systems such as hearing aids and related devices. (2) An audiologist is a person qualified by a master’s degree in audiology, licensed by the state, where applicable, and practicing within the scope of that license. Audiologists evaluate and treat patients with impaired hearing. They plan, direct and conduct rehabilitative programs with audiotry substitutional devises (hearing aids) and other therapy. |
| Notes: Source: (1) American Speech-Language-Hearing Association, (1996, Spring) Scope of practice in Audiology, p. 2 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841743515 | Kali Leanne Markle | Audiologist | 2620 Old Main Hl, Logan, UT 84322 | 2016-07-29 |
| 1790198950 | Matthew R Williams | Audiologist | 1323 West Hunter St., Logan, OH 43138 | 2014-06-05 |
| 1225221609 | John E. Ribera | Audiologist | Dept of Communicative Disorders and Deaf Education, 1000 Old Main Hill, Logan, UT 84322-1000 | 2007-08-20 |
| 1053518563 | Heather Jo Jensen | Audiologist | Usu Hearing Clinic, 1000 Old Main Hill, Logan, UT 84322-1000 | 2007-06-28 |
| 1649475633 | Amy Ann Porter | Audiologist | 6410 Old Main Hl, Logan, UT 84322-6410 | 2007-06-19 |
| 1235350554 | Vernon Nathaniel Mullins | Audiologist | 301 Stratton St, Logan, WV 25601-3911 | 2007-05-02 |
| 1124193347 | Logan Audiology & Hearing Aid Center Inc | Audiologist | 301 Stratton Street, Logan, WV 25601-3511 | 2006-11-22 |
| 1811078124 | Karen Frances Munoz | Audiologist | 2620 Old Main Hill, Northern Illinois Univ Speech-language-hearing Clinic, Logan, UT 84321 | 2006-10-17 |
| 1871509356 | Cache Laurence Pitt | Audiologist | 1000 Old Main Hl, Logan, UT 84322-1000 | 2006-08-01 |
| 1295372522 | Jeremy D Green | Audiologist | 293 S Main St, Logan, UT 84321-5203 | 2019-12-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.