Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 7324191-6009 | UT |
NPI | 1003002544 |
---|---|
Provider Name | Jacqueline Hyde |
First Address | Sandy, UT 84092-4521 |
Second Address | Sandy, UT 84092-4521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2007 |
Last Update Date | 30/06/2009 |