Coahran, Jackie Russell

Coahran, Jackie Russell is an sole proprietor health care provider with primary practice located at 237 26Th St , Ogden UT 84401-3105. She recently has only one registered license in Other Service Providers / Case Manager/Care Coordinator, which is considered as her primary health care specialty. Coahran, Jackie Russell can be contacted via phone (801) 625-3700.

Contact Information

Primary practice address
237 26Th St Ogden UT 84401-3105
Fax: (801) 778-6840
Website:

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Case Manager/Care Coordinator 171M00000X

Profile Details

NPI number 1922294750
LBN Legal business name Coahran, Jackie Russell
Credentials B.S.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 14th, 2007
Last updated Sep 14th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922294750 NPPES
Utah MEDICAID 876000308007

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