Provider Demographics
NPI:1679732226
Name:LARSON, CATHERINE S (CPM LDEM)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:S
Last Name:LARSON
Suffix:
Gender:F
Credentials:CPM LDEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9899 S 3265 W
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3020
Mailing Address - Country:US
Mailing Address - Phone:801-712-8013
Mailing Address - Fax:801-878-3514
Practice Address - Street 1:9899 S 3265 W
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3020
Practice Address - Country:US
Practice Address - Phone:801-712-8013
Practice Address - Fax:801-878-3514
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-08
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6498004-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife