Healthcare Provider Details

I. General information

NPI: 1053053603
Provider Name (Legal Business Name): JOSHUA DANE BEAUCHAMP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14241 S REDWOOD RD STE 300
BLUFFDALE UT
84065-5223
US

IV. Provider business mailing address

2559 S COLT DR
SARATOGA SPRINGS UT
84045-5141
US

V. Phone/Fax

Practice location:
  • Phone: 385-342-2808
  • Fax:
Mailing address:
  • Phone: 208-313-7518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13540735-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: