Individual
JACOB THIEDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
491 E RIVERSIDE DR STE 3A, ST GEORGE, UT 84790-7056
(801) 980-2566
Mailing address
2461 S 780 W, HURRICANE, UT 84737-2648
(801) 831-1841
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/13/2019
Last updated
12/23/2024
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