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General NPI Number Information
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NPI Number | 1154906519
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Entity Type | Individual
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Provider Name | JACOB GARY BARKER
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Gender | Male
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Dates
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Enumeration Date | 03/16/2021
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 3450 S 900 W
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City | SOUTH SALT LAKE
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State | UT
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Zip | 84119-4104
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Country | US
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Telephone | 385-377-4465
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Fax |
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Provider Business Mailing Address
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Address Line | 2636 E STRINGHAM AVE APT A124
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City | SALT LAKE CITY
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State | UT
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Zip | 84109-4902
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Country | US
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Telephone | 354-704-2385
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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