Individual
KRISTY ANN JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC
Contact information
Practice address
2500 S STATE ST, SOUTH SALT LAKE, UT 84115-3164
(385) 646-0545
Mailing address
4332 W GOLF CIR, SOUTH JORDAN, UT 84009-9780
(801) 243-8094
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
9438741-4102
UT
Other
Enumeration date
06/01/2022
Last updated
06/01/2022
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