Individual
DR. STEVEN LAINE JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
500 FOOTHILL DR, SALT LAKE CITY, UT 84148-0001
(801) 582-1565
(801) 584-2507
Mailing address
500 FOOTHILL DR, SALT LAKE CITY, UT 84148-0001
(801) 582-1565
(801) 584-2507
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
116610-2501
UT
Other
Enumeration date
06/08/2006
Last updated
07/08/2007
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