Individual
RICHARD JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2650 WEST 2700 SOUTH, SYRACUSE, UT 84075
(801) 773-0200
Mailing address
2650 WEST 2700 SOUTH, SYRACUSE, UT 84075
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
Primary
—
—
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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