Healthcare Provider Details

I. General information

NPI: 1306127253
Provider Name (Legal Business Name): TRISTYN TEEL WILKERSON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRISTYN LEIGH TEEL PSY.D

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S 500 E SUITE 100
SALT LAKE CITY UT
84102-2015
US

IV. Provider business mailing address

9300 S REDWOOD RD #28-21
WEST JORDAN UT
84088-6607
US

V. Phone/Fax

Practice location:
  • Phone: 801-532-1484
  • Fax: 801-532-1486
Mailing address:
  • Phone: 206-909-3085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: