Individual
MATTHEW V WENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1225 FORT UNION BLVD STE 215, MIDVALE, UT 84047-1882
(801) 501-4350
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 501-4350
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2764342501
UT
Other
Enumeration date
07/17/2006
Last updated
10/18/2007
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