Individual
JACOB K VICKREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
11748 S 3600 W STE 3, SOUTH JORDAN, UT 84095-5922
(801) 896-8133
Mailing address
14664 S WARD HILLS CIR, HERRIMAN, UT 84096-1256
(760) 792-3671
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9742056-3501
UT
Other
Enumeration date
11/02/2018
Last updated
08/16/2024
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