Healthcare Provider Details

I. General information

NPI: 1659546349
Provider Name (Legal Business Name): MARK EVAN JUESCHKE MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12226 S 1000 E STE 9
DRAPER UT
84020-3211
US

IV. Provider business mailing address

12226 S 1000 E STE 9
DRAPER UT
84020-3211
US

V. Phone/Fax

Practice location:
  • Phone: 801-889-5134
  • Fax: 801-889-2003
Mailing address:
  • Phone: 801-889-5134
  • Fax: 801-889-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number11360901-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: