Provider Demographics
NPI:1871213892
Name:WILKINSON, MIRIAM KAY
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:KAY
Last Name:WILKINSON
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 1:910 E DIANA HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5378
Mailing Address - Country:US
Mailing Address - Phone:801-708-1273
Mailing Address - Fax:
Practice Address - Street 1:3740 W MARKET CENTER DR
Practice Address - Street 2:
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065-8026
Practice Address - Country:US
Practice Address - Phone:801-240-9436
Practice Address - Fax:801-240-9452
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical