Individual
JACOB JEFFRY BACZUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1525 LINCOLN AVE, OGDEN, UT 84404-5638
(801) 706-6677
Mailing address
1525 LINCOLN AVE, OGDEN, UT 84404-5638
(801) 706-6677
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
870299862
NONE
UT
Enumeration date
05/02/2019
Last updated
05/02/2019
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