Individual provider Active NPI

Jan Jueschke, MA.

  • Marriage & Family Therapist
  • Draper, UT
National Provider Identifier
1639317589
Registry record updated Dec 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
11360888-3904 Issued in UT
Practice address
13552 S 110 W Ste 204
Draper, UT 84020-2403
Phone
(801) 432-0883
NPI assigned
Jan 30, 2009
Last updated
Dec 2, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 54822 CA
Marriage & Family Therapist 106H00000X 11360888-3904 UT Primary

Addresses

Primary practice location

13552 S 110 W Ste 204
Draper, UT 84020-2403

Mailing address

498 W Sunset Crest Way
Draper, UT 84020-7301
Phone (760) 401-3189

Other practice location 1

791 N Pepper Ave
Colton, CA 92324-1800
Phone (909) 824-0480

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
11360888-3904UTMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
LDS Family Services Past Accepting new patients
Sage Family Counseling, PLLC PastSince Dec 5, 2021 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638403200000",
    "number": "1639317589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "498 W SUNSET CREST WAY",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207301",
            "telephone_number": "760-401-3189",
            "fax_number": "760-401-3189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13552 S 110 W STE 204",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840202403",
            "telephone_number": "801-432-0883"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "791 N Pepper Ave",
            "address_purpose": "LOCATION",
            "city": "Colton",
            "state": "CA",
            "postal_code": "923241800",
            "country_code": "US",
            "telephone_number": "909-824-0480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUESCHKE",
        "first_name": "JAN",
        "name_prefix": "Mrs.",
        "credential": "MA.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-30",
        "last_updated": "2021-12-02",
        "certification_date": "2021-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "54822",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "UT",
            "license": "11360888-3904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Draper, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.