Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 4928114-2501 | UT |
NPI | 1043397375 |
---|---|
Provider Name | Dr. Angela Marie Jette Swanson |
First Address | Park City, UT 84098-5230 |
Second Address | Salt Lake City, UT 84108-2392 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |