Active NPI
Taylor Jackson
- School Psychologist
- South Salt Lake, UT
National Provider Identifier
1194464537
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- Practice address
- 2500 S State St
South Salt Lake, UT 84115-3164 - Phone
- (385) 646-5000
- NPI assigned
- Jun 2, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | Primary |
Addresses
Primary practice location
2500 S State St
South Salt Lake, UT 84115-3164
Mailing address
5522 S Ridgecrest Dr
Taylorsville, UT 84129-7843
Phone (801) 918-3939
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654128000000",
"number": "1194464537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5522 S RIDGECREST DR",
"city": "TAYLORSVILLE",
"state": "UT",
"postal_code": "841297843",
"telephone_number": "801-918-3939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 S STATE ST",
"city": "SOUTH SALT LAKE",
"state": "UT",
"postal_code": "841153164",
"telephone_number": "385-646-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TAYLOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-02",
"last_updated": "2022-06-02",
"certification_date": "2022-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Salt Lake, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.