Provider Demographics
NPI:1023875929
Name:BOUSHKA, CHELSEA SIOBHAN
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:SIOBHAN
Last Name:BOUSHKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 E 3RD AVE APT 501
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-5008
Mailing Address - Country:US
Mailing Address - Phone:915-319-7613
Mailing Address - Fax:915-319-7613
Practice Address - Street 1:14241 S REDWOOD RD STE 300
Practice Address - Street 2:
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065-5223
Practice Address - Country:US
Practice Address - Phone:385-342-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health