Provider Demographics
NPI:1659546349
Name:JUESCHKE, MARK EVAN (MA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:EVAN
Last Name:JUESCHKE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 W SUNSET CREST WAY
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7301
Mailing Address - Country:US
Mailing Address - Phone:760-401-1970
Mailing Address - Fax:
Practice Address - Street 1:825 E 9085 S
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3065
Practice Address - Country:US
Practice Address - Phone:801-826-6678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11360901-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist