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Individual

MRS. HEATHER KAYE JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1200 TOWNE CENTRE BLVD SPC 1142, PROVO, UT 84601-2941
(972) 658-4509
Mailing address
312 MEADOWLARK DR, ALPINE, UT 84004-1371
(972) 658-4509

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
F23-104260
UT

Other

Enumeration date
08/29/2023
Last updated
08/29/2023
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