MEDICARE: AMANDA HARDMAN WILSON LCSW

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	104100000X	Social Worker	0009923203	CO
2	1041C0700X	Clinical Social Worker	12881848-3501	UT

General Provider Information

NPI Number	:	1780281030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA HARDMAN WILSON LCSW

Provider Business Mailing Address
First Line	:	2910 E 3215 S
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84109-2122
Country	:	US
Telephone Number	:	801-520-5247
Fax Number	:

Provider Business Practice Location Address
First Line	:	4578 S HIGHLAND DR STE 190
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84117-4204
Country	:	US
Telephone Number	:	801-520-5247
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	10/15/2024

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