Richard Jackson

NPI #1124240197 in Syracuse, Utah

Provider Information

NPI Number: 1124240197
Entity Type: Individual
Name: Richard Jackson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Psychologist - Rehabilitation
Enumeration Date: May 2, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 2650 WEST 2700 SOUTH
City: Syracuse
State: Utah
ZIP Code: 84075
Phone: (801) 773-0200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Rehabilitation — Rehabilitation	103TR0400X	Primary

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