Provider Demographics
NPI:1912632258
Name:HO, WAN (PSYD)
Entity Type:Individual
Prefix:
First Name:WAN
Middle Name:
Last Name:HO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-3554
Mailing Address - Country:US
Mailing Address - Phone:801-344-4215
Mailing Address - Fax:801-344-4225
Practice Address - Street 1:1300 E CENTER ST
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-3554
Practice Address - Country:US
Practice Address - Phone:801-344-4215
Practice Address - Fax:801-344-4225
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13742548-2504103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist