Organization
IMPACT COMMUNITY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAZZAMIN CLARK (MANAGER)
(385) 775-0777
Entity
Organization
Contact information
Practice address
202 E 5900 S, SALT LAKE CITY, UT 84107-7330
(385) 775-0777
Mailing address
202 E 5900 S, SALT LAKE CITY, UT 84107-7330
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
10/24/2025
Last updated
10/24/2025
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