Healthcare Provider Details

I. General information

NPI: 1366211302
Provider Name (Legal Business Name): MAKAYLA DUSCH ED.S., LPCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2024
Last Update Date: 01/01/2024
Certification Date: 12/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 W BROADWAY STE 222
SALT LAKE CITY UT
84101-2038
US

IV. Provider business mailing address

8455 S IVY GABLE DR
WEST JORDAN UT
84081-5068
US

V. Phone/Fax

Practice location:
  • Phone: 814-761-7041
  • Fax:
Mailing address:
  • Phone: 814-761-7041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: