Individual
BRUCE KENNETH JACOBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., P.C.
Contact information
Practice address
4190 HIGHLAND DR, SUITE 211, SALT LAKE CITY, UT 84124-2600
(801) 272-0614
Mailing address
4190 HIGHLAND DR, SUITE 211, SALT LAKE CITY, UT 84124-2600
(801) 272-0614
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
450510082
UT
Other
Enumeration date
02/29/2008
Last updated
03/14/2018
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