Provider Demographics
NPI:1922337047
Name:DUNN, TODD WILSON (PHD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:WILSON
Last Name:DUNN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6186 W ARGO CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3691
Mailing Address - Country:US
Mailing Address - Phone:801-763-4824
Mailing Address - Fax:
Practice Address - Street 1:7084 S 2300 E STE 120
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3978
Practice Address - Country:US
Practice Address - Phone:801-944-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-19
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7223032-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical