Healthcare Provider Details

I. General information

NPI: 1073939252
Provider Name (Legal Business Name): CHOICE SUPPORTED EMPLOYMENT OF UTAH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 E 3600 N
NORTH OGDEN UT
84414-7563
US

IV. Provider business mailing address

456 E 3600 N
NORTH OGDEN UT
84414-7563
US

V. Phone/Fax

Practice location:
  • Phone: 801-726-3563
  • Fax: 801-883-8316
Mailing address:
  • Phone: 801-726-3563
  • Fax: 801-883-8316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1958
License Number StateUT

VIII. Authorized Official

Name: LAURIE JAUSSI
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 801-726-3563