Individual
JONATHAN THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
75 S 1ST W, PRESTON, ID 83263-1204
(208) 852-2370
Mailing address
1327 N 25 E, LAYTON, UT 84041-2977
(435) 512-6453
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LMSW-44232
ID
Other
Enumeration date
10/30/2023
Last updated
10/30/2023
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