Provider Demographics
NPI:1841260429
Name:REICHELT, JAMES ROSS (RN, SSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROSS
Last Name:REICHELT
Suffix:
Gender:M
Credentials:RN, SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 FORTUNA WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3349
Mailing Address - Country:US
Mailing Address - Phone:801-274-2675
Mailing Address - Fax:
Practice Address - Street 1:4460 HIGHLAND DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3543
Practice Address - Country:US
Practice Address - Phone:801-273-6356
Practice Address - Fax:801-273-6363
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134907-3102163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107030194101OtherINTERMTN. HEALTH CARE
UT107030194101OtherINTERMTN. HEALTH CARE