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General NPI Number Information
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NPI Number | 1770597726
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Entity Type | Individual
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Provider Name | SUSAN MARIE WIET M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 160 S 1000 E STE 220
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-1552
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Country | US
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Telephone | 978-743-9438
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Fax | 844-838-8100
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Provider Business Mailing Address
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Address Line | 850 E 300 S STE 1
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-2301
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Country | US
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Telephone | 385-429-9808
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Fax | 844-838-8100
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 371106
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License Number State | UT
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