Individual
KIMBERLY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11042 N 5500 W, HIGHLAND, UT 84003-9503
(801) 660-0265
Mailing address
11042 N 5500 W, HIGHLAND, UT 84003-9503
(801) 660-0265
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12886020-6006
UT
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
128860206014
UT
Other
Enumeration date
07/21/2022
Last updated
04/14/2025
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