Healthcare Provider Details

I. General information

NPI: 1316716921
Provider Name (Legal Business Name): JASON GIANCHETTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 W 750 S STE A
WOODS CROSS UT
84010-7221
US

IV. Provider business mailing address

403 STONY LANDING RD
MONCKS CORNER SC
29461-3967
US

V. Phone/Fax

Practice location:
  • Phone: 801-935-8449
  • Fax:
Mailing address:
  • Phone: 843-761-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberF23-109242
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: