MEDICARE: WILDE THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1528913134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILDE THERAPY

Provider Business Mailing Address
First Line	:	2879 VIRGINIA WAY
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-0452
Country	:	US
Telephone Number	:	801-644-1456
Fax Number	:

Provider Business Practice Location Address
First Line	:	2568 WASHINGTON BLVD STE 200
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84401-3114
Country	:	US
Telephone Number	:	801-644-1456
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CRAIG WILDE
Credential	:	LCSW
Telephone Number	:	801-644-1456

Provider Enumeration Date	:	02/27/2026
Last Update Date	:	03/02/2026

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Directions to “WILDE THERAPY ” Practice Location

Language	Start Address	Practice Location

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