Individual
JACKSON TYLER LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
515 S 700 E STE 2A, SALT LAKE CITY, UT 84102-2855
(800) 434-8923
Mailing address
785 E 550 N, EPHRAIM, UT 84627-1208
(435) 851-7427
(801) 935-4946
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
UT
Other
Enumeration date
01/25/2021
Last updated
01/25/2021
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