Individual
JESSICA WYLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1159 N 1165 W, OREM, UT 84057-6400
(801) 389-2381
Mailing address
1159 N 1165 W, OREM, UT 84057-6400
(801) 389-2381
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
10108693-6018
UT
104100000X
Social Worker
Primary
10108693-3502
UT
Other
Enumeration date
02/13/2018
Last updated
07/21/2022
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