Provider Demographics
NPI:1982219168
Name:WISEMAN, SAVANNAH JANE (MD)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:JANE
Last Name:WISEMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:JANE
Other - Last Name:BRIMHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1140 W 1130 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 S 700 E STE 2A
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2855
Practice Address - Country:US
Practice Address - Phone:800-434-8923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst