Individual
DERICK JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
68 S 600 E, SLC, UT 84102-1007
(801) 322-1001
(801) 359-3864
Mailing address
5410 W 13680 S, HERRIMAN, UT 84096-1710
(801) 322-1001
(801) 359-3864
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
01/30/2014
Last updated
01/30/2014
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