Provider Demographics
NPI:1992840888
Name:ANGELA JETTE SWANSON, PH.D., LLC
Entity Type:Organization
Organization Name:ANGELA JETTE SWANSON, PH.D., LLC
Other - Org Name:ANGELA JETTE SWANSON, PH.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JETTE SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:435-640-2677
Mailing Address - Street 1:310 MATTERHORN DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5230
Mailing Address - Country:US
Mailing Address - Phone:435-640-2677
Mailing Address - Fax:
Practice Address - Street 1:1400 FOOTHILL DR STE 24
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2392
Practice Address - Country:US
Practice Address - Phone:801-581-0422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty