Paul Wiederhold

NPI 1245651348 · on the registry since 2013 · sole proprietor

Practice

Address: 704 N State Road 51
Spanish Fork, UT 84660
Phone: (801) 794-0318
Organisation at this address: Extended Family
Magellan Academy, Inc
Extended Family, Inc.
Extended Family Boys, Inc.
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 13

Registry record

Primary taxonomy: 253J00000X
253J00000X
Licence states on file: UT
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2013-12-17

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Utah