Provider Demographics
NPI:1619522232
Name:JOHNSON-WHEELOCK, RYLEE (CASUDC)
Entity Type:Individual
Prefix:
First Name:RYLEE
Middle Name:
Last Name:JOHNSON-WHEELOCK
Suffix:
Gender:F
Credentials:CASUDC
Other - Prefix:
Other - First Name:RYLEE
Other - Middle Name:
Other - Last Name:BUNTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:230 W 400 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-1829
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 W 400 S STE 103
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1841
Practice Address - Country:US
Practice Address - Phone:801-359-8862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTRBT-19-90465246Z00000X
UT13359503-6018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other