Healthcare Provider Details

I. General information

NPI: 1992840888
Provider Name (Legal Business Name): ANGELA JETTE SWANSON, PH.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FOOTHILL DR STE 24
SALT LAKE CITY UT
84108-2392
US

IV. Provider business mailing address

310 MATTERHORN DR
PARK CITY UT
84098-5230
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-0422
  • Fax:
Mailing address:
  • Phone: 435-640-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELA MARIE JETTE SWANSON
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 435-640-2677