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NPI Code Detail

MEDICARE: WESLEY DANIEL SPENCER

MEDICARE: WESLEY DANIEL SPENCER
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
1103TC0700XClinical Psychologist4803198-2501UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1870401386SP1OTHERUTEMIA
270578OTHERUTPEHP
3107003178101OTHERUTIHC PROVIDER NETWORK

General Provider Information

NPI Number : 1750486809
Entity Type Code : Individual
Provider Name (Legal Business Name) : WESLEY DANIEL SPENCER
Provider Business Mailing Address
First Line : 405 EDGEWOOD DR
Second Line :
City : PROVIDENCE
State : UT
Zip : 84332-9471
Country : US
Telephone Number : 435-750-6118
Fax Number :
Provider Business Practice Location Address
First Line : 90 E 200 N
Second Line :
City : LOGAN
State : UT
Zip : 84321-4034
Country : US
Telephone Number : 435-752-0750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2006
Last Update Date : 07/08/2007

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Directions to “ WESLEY DANIEL SPENCER ” Practice Location

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