Healthcare Provider Details

I. General information

NPI: 1245601954
Provider Name (Legal Business Name): ANDREA PUCHAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3069 E FINLANDIA CT
COTTONWOOD HEIGHTS UT
84093-6545
US

IV. Provider business mailing address

3069 FINLANDIA CT.
COTTONWOOD HEIGHTS UT
84093
US

V. Phone/Fax

Practice location:
  • Phone: 801-671-0593
  • Fax:
Mailing address:
  • Phone: 801-671-0593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9329660-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: