Provider Demographics
NPI:1043484223
Name:SEAMONS, CARLA
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:
Last Name:SEAMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 N 400 E STE D
Mailing Address - Street 2:
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-1756
Mailing Address - Country:US
Mailing Address - Phone:435-753-7880
Mailing Address - Fax:435-753-5845
Practice Address - Street 1:2380 N 400 E STE D
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1756
Practice Address - Country:US
Practice Address - Phone:435-753-7880
Practice Address - Fax:435-753-5845
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT111339-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT111339-4101OtherSTATE LICENSE
UT01070999OtherAMER. SPEECH/ HEARING AS.