Provider Demographics
NPI:1245035161
Name:JACCARD, JARED ALTON (LMT)
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:ALTON
Last Name:JACCARD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 E EMELITA ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6536
Mailing Address - Country:US
Mailing Address - Phone:801-842-9940
Mailing Address - Fax:
Practice Address - Street 1:1253 E EMELITA ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-6536
Practice Address - Country:US
Practice Address - Phone:801-842-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14070400-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist