Most Relevant Information
Provider Data
| NPI Number: | 1003322959 |
| Provider Name: | JESSIE ROSE CORBRIDGE |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/14/2017 |
| Last Updated: | 12/14/2017 |
Provider Practice Location
447 W BEARCAT DR
SALT LAKE CITY
UT
841152519
Practice Location Phone/Fax
| Phone: | 8013552846 |
| Fax: |
Provider Mailing Location
447 W BEARCAT DR
SALT LAKE CITY
UT
841152519
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |