Provider Demographics
NPI:1033384672
Name:WIMMER, ROBERT (LCSW, MSCJA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:WIMMER
Suffix:
Gender:M
Credentials:LCSW, MSCJA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10087 S COPPER PIT CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-2443
Mailing Address - Country:US
Mailing Address - Phone:385-439-3674
Mailing Address - Fax:
Practice Address - Street 1:10087 S COPPER PIT CIR
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-2443
Practice Address - Country:US
Practice Address - Phone:385-439-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8108830-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical