Wasatch Psychological Services, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

10086571-2501 Issued in UT

Legal business name

WASATCH PSYCHOLOGICAL SERVICES, LLC

Practice address

1060 E 100 S
Suite 100
Salt Lake City, UT 84102-1501

Phone

(801) 590-0525

NPI assigned

Jan 23, 2017

Last updated

Jan 23, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ryan W Wilkes, PSYDNPI 1447522859

Title

Clinical Psychologist

Phone

(540) 421-6660

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ryan Woodrow Wilkes, PSYD

  • Clinical Psychologist
  • Salt Lake City, UT
  • NPI 1447522859
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1485129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485129600000",
    "number": "1336686856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1443 E LAIRD AVE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841051938",
            "telephone_number": "540-421-6660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 E 100 S",
            "address_2": "SUITE 100",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021501",
            "telephone_number": "801-590-0525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASATCH PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-23",
        "last_updated": "2017-01-23",
        "status": "A",
        "authorized_official_last_name": "WILKES",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "540-421-6660",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "UT",
            "license": "10086571-2501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wasatch Physical Therapy & Rehabilitation, Inc
• Wasatch Physical Therapy and Rehabilation Center
• Wasatch Physical Therapy and Rehabilitation, Inc
• Wasatch Primary Care PLLC
• Wasatch Psychological Serivces, PLLC
• Wasatch Sleep Health Center, Inc
• Wasatch Spring LLC
• Wasatch Therapy Group
• Wasatch Urology Associates
• Wasatch Vascular Center ASC LLC

• Psychologist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Psychologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.