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General NPI Number Information
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NPI Number | 1629964838
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Entity Type | Individual
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Provider Name | JACOB CHARLES CALDER CSW
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Gender | Male
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 845 W 200 N
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City | KAYSVILLE
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State | UT
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Zip | 84037-2406
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Country | US
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Telephone | 801-872-6426
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Fax |
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Provider Business Mailing Address
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Address Line | 7313 W AFTERGLOW LN
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City | WEST VALLEY CITY
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State | UT
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Zip | 84081-1206
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Country | US
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Telephone | 859-221-0013
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14222743-3502
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License Number State | UT
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