Individual
MICHAEL ROBERT JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSW
Contact information
Practice address
1220 N MAIN ST STE 10, SPRINGVILLE, UT 84663-4016
(801) 358-4463
Mailing address
1220 N MAIN ST STE 10, SPRINGVILLE, UT 84663-4016
(801) 358-4463
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
118051-3502
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
118051-3502
DOPL
UT
Enumeration date
01/02/2018
Last updated
01/02/2018
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