Provider Demographics
NPI:1306127253
Name:WILKERSON, TRISTYN TEEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:TRISTYN
Middle Name:TEEL
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TRISTYN
Other - Middle Name:LEIGH
Other - Last Name:TEEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:9300 S REDWOOD RD
Mailing Address - Street 2:#28-21
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-6607
Mailing Address - Country:US
Mailing Address - Phone:206-909-3085
Mailing Address - Fax:
Practice Address - Street 1:230 S 500 E
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2015
Practice Address - Country:US
Practice Address - Phone:801-532-1484
Practice Address - Fax:801-532-1486
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist