Individual
JORDAN KEVIN WOODRUFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11715 S STATE ST APT E204, DRAPER, UT 84020-6910
(208) 965-4563
Mailing address
11715 S STATE ST APT E204, DRAPER, UT 84020-6910
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-15-2763-06274
UT
Other
Enumeration date
04/08/2019
Last updated
04/08/2019
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