Individual
JACOB EVERTSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BEHAVIOR TECHNICIAN
Contact information
Practice address
515 S 700 E STE 2A, SALT LAKE CITY, UT 84102-2855
(801) 935-4171
(801) 935-4946
Mailing address
515 S 700 E STE 2A, SALT LAKE CITY, UT 84102-2855
(801) 935-4171
(801) 935-4946
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/19/2021
Last updated
07/19/2021
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