Provider Demographics
NPI:1215822507
Name:WRIBEN, JAMIE RANAE (PHD, MTRS, CTRS)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:RANAE
Last Name:WRIBEN
Suffix:
Gender:F
Credentials:PHD, MTRS, CTRS
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:RANAE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, MTRS, CTRS
Mailing Address - Street 1:8171 N IRON HORSE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE POINT
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3496
Mailing Address - Country:US
Mailing Address - Phone:801-633-9254
Mailing Address - Fax:
Practice Address - Street 1:150 WHITE SAGE AVE
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:UT
Practice Address - Zip Code:84624-8928
Practice Address - Country:US
Practice Address - Phone:801-633-9254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10793956-4001225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist