Individual
JACOB EUGENE JACQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5814 S 900 E, MURRAY, UT 84121-1644
(385) 800-3272
(385) 800-3260
Mailing address
5814 S 900 E, MURRAY, UT 84121-1644
(801) 548-9696
(385) 800-3260
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
0904013199
VA
1041C0700X
Clinical Social Worker
4671239
ID
1041C0700X
Clinical Social Worker
Primary
7915180-3501
UT
1041C0700X
Clinical Social Worker
LCSW-871
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1025579
—
UT
Enumeration date
08/30/2011
Last updated
12/06/2024
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