Provider Demographics
NPI:1689977191
Name:JAUSSI, VICKIE DEONE (LASUDC)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:DEONE
Last Name:JAUSSI
Suffix:
Gender:F
Credentials:LASUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 W 690 N
Mailing Address - Street 2:
Mailing Address - City:SANTAQUIN
Mailing Address - State:UT
Mailing Address - Zip Code:84655-7907
Mailing Address - Country:US
Mailing Address - Phone:801-851-7663
Mailing Address - Fax:
Practice Address - Street 1:169 W 690 N
Practice Address - Street 2:
Practice Address - City:SANTAQUIN
Practice Address - State:UT
Practice Address - Zip Code:84655-7907
Practice Address - Country:US
Practice Address - Phone:801-851-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT354989-6006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)