| Wasatch Psychological Services, Llc | |
|
1060 E 100 S Suite 100 Salt Lake City UT 84102-1501 | |
| (801) 590-0525 | |
| Not Available |
| Full Name | Wasatch Psychological Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1060 E 100 S, Salt Lake City, Utah |
| Authorized Official Name and Position | Ryan W Wilkes (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 5404216660 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wasatch Psychological Services, Llc 1443 E Laird Ave Salt Lake City UT 84105-1938 Ph: (540) 421-6660 | Wasatch Psychological Services, Llc 1060 E 100 S Suite 100 Salt Lake City UT 84102-1501 Ph: (801) 590-0525 |
| NPI Number | 1336686856 |
|---|---|
| Provider Enumeration Date | 01/23/2017 |
| Last Update Date | 01/23/2017 |
| Medicare PECOS PAC ID | 9638453061 |
|---|---|
| Medicare Enrollment ID | O20170303001114 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336686856 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 10086571-2501 (Utah) | Primary |
| Provider Name | Ryan W Wilkes |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447522859 PECOS PAC ID: 0547544975 Enrollment ID: I20170303001158 |
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