Provider Demographics
NPI:1619522232
Name:JOHNSON-WHEELOCK, RYLEE (LASUDC)
Entity type:Individual
Prefix:
First Name:RYLEE
Middle Name:
Last Name:JOHNSON-WHEELOCK
Suffix:
Gender:F
Credentials:LASUDC
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 1:64 MAIN ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3701
Practice Address - Country:US
Practice Address - Phone:603-357-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13359503-6018101YA0400X
UTRBT-19-90465246Z00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other