Provider Demographics
NPI:1912758723
Name:JACOBSON, KAYLA (MDA, RDN, CD)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MDA, RDN, CD
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:WOOLLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:542 N HELMSMAN LN
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84045-5665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:542 N HELMSMAN LN
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84045-5665
Practice Address - Country:US
Practice Address - Phone:805-405-7375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT86148274133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered