Healthcare Provider Details

I. General information

NPI: 1700596566
Provider Name (Legal Business Name): RACHEAL SUSAETA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8754 S OKUBO DR
WEST JORDAN UT
84088-5701
US

IV. Provider business mailing address

8754 S OKUBO DR
WEST JORDAN UT
84088-5701
US

V. Phone/Fax

Practice location:
  • Phone: 801-231-0108
  • Fax:
Mailing address:
  • Phone: 801-231-0108
  • Fax: 801-601-1578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: