Individual
MRS. JACKIE RUSSELL COAHRAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
237 26TH ST, OGDEN, UT 84401-3105
(801) 625-3700
(801) 778-6840
Mailing address
237 26TH ST, OGDEN, UT 84401-3105
(801) 625-3700
(801) 778-6840
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
876000308007
—
UT
Enumeration date
09/14/2007
Last updated
09/14/2007
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