Individual
BROOKLYNN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
647 E 400 S, PROVO, UT 84606-5064
(360) 607-6306
Mailing address
647 E 400 S, PROVO, UT 84606-5064
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
14248968-4901
UT
Other
Enumeration date
11/11/2025
Last updated
11/11/2025
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