Individual
KARENA Z JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPPP
Contact information
Practice address
5047 S GALLERIA DR, SALT LAKE CITY, UT 84123-4695
(801) 486-8143
(801) 746-6090
Mailing address
5047 S GALLERIA DR, SALT LAKE CITY, UT 84123-4695
(801) 486-8143
(801) 746-6090
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/10/2020
Last updated
07/10/2020
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