Individual
MR. JACOB ALTON GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4460 S HIGHLAND DR, SALT LAKE CITY, UT 84124-3543
(888) 949-4864
(801) 373-0639
Mailing address
4460 S HIGHLAND DR, SALT LAKE CITY, UT 84124-3543
(888) 949-4864
(801) 373-0639
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
09/07/2020
Last updated
09/28/2022
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