Provider Demographics
NPI:1154906519
Name:BARKER, JACOB GARY
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:GARY
Last Name:BARKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 E STRINGHAM AVE APT A124
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-4902
Mailing Address - Country:US
Mailing Address - Phone:354-704-2385
Mailing Address - Fax:
Practice Address - Street 1:3450 S 900 W
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84119-4104
Practice Address - Country:US
Practice Address - Phone:385-377-4465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker