Richard Jackson
Psychologist, Rehabilitation in Syracuse, UT. Individual provider (NPI-1).
NPI number1124240197
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1124240197
- Entity type
- Individual (NPI-1)
- Name
- Richard Jackson
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- May 2, 2007
- Last updated
- Jul 8, 2007
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TR0400X | Psychologist, Rehabilitation | – | – | Yes |
Practice location
2650 West 2700 SouthSyracuse, UT 84075
Phone 801-773-0200
Mailing address
2650 West 2700 SouthSyracuse, UT 84075
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