Provider Demographics
NPI:1790289098
Name:SOVEGNA PLLC
Entity Type:Organization
Organization Name:SOVEGNA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-915-3698
Mailing Address - Street 1:850 E 300 S STE 1
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2301
Mailing Address - Country:US
Mailing Address - Phone:385-429-9808
Mailing Address - Fax:844-838-8100
Practice Address - Street 1:850 E 300 S STE 1
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2301
Practice Address - Country:US
Practice Address - Phone:385-429-9808
Practice Address - Fax:844-838-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT371205-11062084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty