Provider Demographics
NPI:1992011860
Name:ANDREASON, JACOB R
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:R
Last Name:ANDREASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10808 S RIVER FRONT PKWY STE 308
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5761
Mailing Address - Country:US
Mailing Address - Phone:801-984-6728
Mailing Address - Fax:801-984-4715
Practice Address - Street 1:10808 S RIVER FRONT PKWY STE 308
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5761
Practice Address - Country:US
Practice Address - Phone:801-984-6728
Practice Address - Fax:801-984-4715
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-29
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health