Individual
JACLYN ANDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSW
Contact information
Practice address
380 W 1400 N, LOGAN, UT 84341-6813
(435) 752-8880
Mailing address
297 W 1000 N, LOGAN, UT 84321-2239
(435) 757-0917
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
77503153502
UT
Other
Enumeration date
07/13/2011
Last updated
07/13/2011
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