Individual
JERICHO CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3006 S HIGHLAND DR STE 210, SALT LAKE CITY, UT 84106-6004
(801) 647-3920
Mailing address
3006 S HIGHLAND DR STE 210, SALT LAKE CITY, UT 84106-6004
(801) 647-3920
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/06/2020
Last updated
10/06/2020
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