Individual
MRS. KELLI CLARK JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
450 S 900 E STE 300, SALT LAKE CITY, UT 84102-3064
(801) 534-7916
(801) 532-3608
Mailing address
450 S 900 E STE 300, SALT LAKE CITY, UT 84102-3064
(801) 534-7916
(801) 532-3608
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6953774-3501
UT
Other
Enumeration date
02/15/2007
Last updated
10/18/2010
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