Provider Demographics
NPI:1841433869
Name:JACKSON, DAWN FLEMING (PHD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:FLEMING
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S 600 E
Mailing Address - Street 2:SUITE 4A AMBASSADOR PLAZA
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1999
Mailing Address - Country:US
Mailing Address - Phone:801-364-3222
Mailing Address - Fax:801-364-3336
Practice Address - Street 1:150 S 600 E
Practice Address - Street 2:SUITE 4A AMBASSADOR PLAZA
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1999
Practice Address - Country:US
Practice Address - Phone:801-364-3222
Practice Address - Fax:801-364-3336
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5081773-2501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling