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General NPI Number Information
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NPI Number | 1073939252
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Entity Type | Organization
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Legal Business Name | CHOICE SUPPORTED EMPLOYMENT OF UTAH, INC.
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 456 E 3600 N
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City | NORTH OGDEN
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State | UT
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Zip | 84414-7563
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Country | US
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Telephone | 801-726-3563
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Fax | 801-883-8316
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Provider Business Mailing Address
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Address Line | 456 E 3600 N
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City | NORTH OGDEN
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State | UT
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Zip | 84414-7563
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Country | US
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Telephone | 801-726-3563
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Fax | 801-883-8316
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | LAURIE JAUSSI
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Credential |
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Telephone | 801-726-3563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1958
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License Number State | UT
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