Provider Demographics
NPI:1073939252
Name:CHOICE SUPPORTED EMPLOYMENT OF UTAH, INC.
Entity Type:Organization
Organization Name:CHOICE SUPPORTED EMPLOYMENT OF UTAH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAUSSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-726-3563
Mailing Address - Street 1:456 E 3600 N
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-7563
Mailing Address - Country:US
Mailing Address - Phone:801-726-3563
Mailing Address - Fax:801-883-8316
Practice Address - Street 1:456 E 3600 N
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-7563
Practice Address - Country:US
Practice Address - Phone:801-726-3563
Practice Address - Fax:801-883-8316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1958251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health