Provider Demographics
NPI:1497194906
Name:WYNER, GAYLE (LCSW)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:WYNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 S STATE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7144
Mailing Address - Country:US
Mailing Address - Phone:801-867-3472
Mailing Address - Fax:801-401-7850
Practice Address - Street 1:11650 S STATE ST STE 104
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7144
Practice Address - Country:US
Practice Address - Phone:801-867-3472
Practice Address - Fax:801-401-7850
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5546112-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical