Jacqueline A Wynder

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

515 S 700 E Ste 2a
Salt Lake City, UT 84102-2855

Phone

(801) 935-4171

NPI assigned

May 17, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jacqueline Anne Roark Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558051200000",
    "number": "1285290908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "791 E VINE ST APT 203",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841076586",
            "telephone_number": "253-861-0042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 S 700 E STE 2A",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841022855",
            "telephone_number": "801-935-4171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNDER",
        "first_name": "JACQUELINE",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-17",
        "last_updated": "2019-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "ROARK",
            "middle_name": "ANNE",
            "credential": "AI HUA, WANG",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Whitney Wyatt
• Katherine Wycoff, OTR/L
• Dennis Jon Wyman, M.D.
• Bret Wynder, PHARMD
• Esther Wynder
• Brian Wyrowski
• Corinne Xanthos, DPT
• Yu Xia
• Changhong Xing
• Qingyu Xu, MD

• Behavior Technician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Behavior Technician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.