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Contact Information

JOHN L JACKSON, PHD
3056 S 700 E APT C
SALT LAKE CITY, UT84106-1682
 Phone: 706-936-6422
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Counseling

103TC1900X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for JOHN L JACKSON · (Male)

NPI # 1649973850
Status Active
Credentials PHD
Entity Individual
Enumeration date 03/24/2023
Last updated 03/24/2023 - About 3 years ago
Sole proprietor 1 Yes
Identifiers
  • UT License # 12900024-2501
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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