Individual
JACKSON JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
12272 S 800 E STE D, DRAPER, UT 84020-9776
(801) 923-3537
Mailing address
1340 N FREEDOM BLVD APT 221, PROVO, UT 84604-5823
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-468097
UT
Other
Enumeration date
10/31/2025
Last updated
10/31/2025
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