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1891071973
MATTHEW ADRIAN JACKMAN
SALT LAKE CITY, UT
NPI
1891071973
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2011-11-02
Last Update Date
2011-11-02
Business Address
-- MATTHEW ADRIAN JACKMAN
447 BEARCAT DR
SALT LAKE CITY, UT 84115-2519
Phone number: 801-355-2846
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Mailing Address
-- MATTHEW ADRIAN JACKMAN
447 BEARCAT DR
SALT LAKE CITY, UT 84115-2519
Phone number: 801-355-2846
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