Provider Demographics
NPI:1306278999
Name:DUSOE, TAMMIE LUE (ASUDC)
Entity type:Individual
Prefix:
First Name:TAMMIE
Middle Name:LUE
Last Name:DUSOE
Suffix:
Gender:F
Credentials:ASUDC
Other - Prefix:
Other - First Name:TAMMIE
Other - Middle Name:LUE
Other - Last Name:BENDIXEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8465 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0501
Mailing Address - Country:US
Mailing Address - Phone:801-233-8577
Mailing Address - Fax:801-233-8748
Practice Address - Street 1:8465 S 700 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-0501
Practice Address - Country:US
Practice Address - Phone:801-233-8577
Practice Address - Fax:801-233-8748
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT346406-6008101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)