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NPI Code Detail

MEDICARE: JENNIFER WEHAN

MEDICARE:   JENNIFER  WEHAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC2200XClinical Child & Adolescent Psychologist

General Provider Information

NPI Number : 1457808370
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER WEHAN
Provider Business Mailing Address
First Line : 350 S 400 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-2905
Country : US
Telephone Number : 801-582-5534
Fax Number :
Provider Business Practice Location Address
First Line : 350 S 400 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-2905
Country : US
Telephone Number : 801-582-5534
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2016
Last Update Date : 09/08/2016

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Directions to “ JENNIFER WEHAN ” Practice Location

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