Provider Demographics
NPI:1730409517
Name:WILSON, TAUNYA LYN
Entity type:Individual
Prefix:
First Name:TAUNYA
Middle Name:LYN
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13073 WHEATFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9253
Mailing Address - Country:US
Mailing Address - Phone:801-386-0356
Mailing Address - Fax:801-495-2076
Practice Address - Street 1:13073 WHEATFIELD WAY
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9253
Practice Address - Country:US
Practice Address - Phone:801-386-0356
Practice Address - Fax:801-495-2076
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children