NPI 1023905924

Ethan Prusse

Practitioner Case Manager/Care Coordinator Tooele, UT

Practice location

Address: 100 S 1000 W, Tooele, UT 84074-4010
Phone: (888) 949-4864
Mailing address: 3725 W 4100 S STE 201, West Valley City, UT 84120-6490

Registered specialties

Case Manager/Care Coordinator Primary

Other Service Providers Taxonomy 171M00000X Licence F25-125714 (UT)

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Registry record

NPI: 1023905924
Entity type: Individual
Sex (as registered): Male
NPI issued: 23 Jun 2025
Record last updated: 2 Jul 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.