Individual
BROOKE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
585 E LAKEVIEW PKWY BLDG 6, PROVO, UT 84606-7312
(801) 935-4171
Mailing address
585 E LAKEVIEW PKWY BLDG 6, PROVO, UT 84606-7312
(801) 935-4171
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/27/2026
Last updated
02/27/2026
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