Individual
JESSICA WACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1782 HOLLADAY BLVD, SALT LAKE CITY, UT 84124-2606
(801) 703-5321
Mailing address
1782 HOLLADAY BLVD, SALT LAKE CITY, UT 84124-2606
(801) 703-5321
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7727205-6004
UT
Other
Enumeration date
04/09/2007
Last updated
01/12/2012
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