Individual
DR. JESSE GORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
1060 E 100 S, SUITE 105, SALT LAKE CITY, UT 84102-1501
(801) 532-7414
Mailing address
4659 BROOKWOOD DR, SALT LAKE CITY, UT 84117-4909
(801) 532-7414
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
50251392501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107029545101
U006
UT
01
—
8573690
U002
UT
01
—
942938348015
U009
UT
01
—
Q11013
ICAR
UT
Enumeration date
12/13/2005
Last updated
10/18/2007
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