| Bruce K Jacobson Ph D P C | |
|
4190 Highland Dr Suite 211 Salt Lake City UT 84124-2600 | |
| (801) 272-0614 | |
| (801) 272-0678 |
| Full Name | Bruce K Jacobson Ph D P C |
|---|---|
| Speciality | Clinic/Center |
| Location | 4190 Highland Dr, Salt Lake City, Utah |
| Authorized Official Name and Position | Bruce K Jacobson (PRESIDENT AND PSYCHOLOGIST) |
| Authorized Official Contact | 8012720614 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bruce K Jacobson Ph D P C 4190 Highland Dr Suite 211 Salt Lake City UT 84124-2600 Ph: (801) 272-0614 | Bruce K Jacobson Ph D P C 4190 Highland Dr Suite 211 Salt Lake City UT 84124-2600 Ph: (801) 272-0614 |
| NPI Number | 1417913575 |
|---|---|
| Provider Enumeration Date | 04/26/2006 |
| Last Update Date | 03/16/2018 |
| Medicare PECOS PAC ID | 2264407030 |
|---|---|
| Medicare Enrollment ID | O20040826000905 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417913575 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 1162592501 (Utah) | Primary |
| Provider Name | Bruce K Jacobson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679743009 PECOS PAC ID: 6608841481 Enrollment ID: I20040826000954 |
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