Bruce K Jacobson PH D P C

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

1162592501 Issued in UT

Legal business name

BRUCE K JACOBSON PH D P C

Practice address

4190 Highland Dr
Suite 211
Salt Lake City, UT 84124-2600

Phone

(801) 272-0614

Fax

(801) 272-0678

NPI assigned

Apr 26, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bruce K Jacobson, PH D P CNPI 1679743009

Title

President and Psychologist

Phone

(801) 272-0614

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bruce Kenneth Jacobson, PH.D., P.C.

  • Psychologist
  • Salt Lake City, UT
  • NPI 1679743009
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521158400000",
    "number": "1417913575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4190 HIGHLAND DR",
            "address_2": "SUITE 211",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841242600",
            "telephone_number": "801-272-0614",
            "fax_number": "801-272-0678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 HIGHLAND DR",
            "address_2": "SUITE 211",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841242600",
            "telephone_number": "801-272-0614",
            "fax_number": "801-272-0678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCE K JACOBSON PH D P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2018-03-16",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT AND PSYCHOLOGIST",
        "authorized_official_telephone_number": "801-272-0614",
        "authorized_official_credential": "PH D P C"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "UT",
            "license": "1162592501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa Browning
• Shainya Tay Brownlee
• Edward Eugene Broyles, CPSS
• Ryan Michael Brubaker
• Bruce G Evans MD PC
• Alysha Bruce, LCSW
• Andra Marie Bruce, LCSW
• Jennifer Bruce
• Marshall Bruce
• Renee Bruder, CCC-SLP

• Adult Mental Health Clinic/Center in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Adult Mental Health Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.