Individual
SHELLY JO WAHLSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CHT, PHD
Contact information
Practice address
2827 W 4400 S, ROY, UT 84067-8951
(801) 643-3211
Mailing address
2827 W 4400 S, ROY, UT 84067-8951
(801) 643-3211
Taxonomy
Speciality
Code
Description
License number
State
374K00000X
Religious Nonmedical Practitioner
Primary
374K00000X
AZ
Other
Enumeration date
07/11/2025
Last updated
07/11/2025
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