Healthcare Provider Details

I. General information

NPI: 1477737468
Provider Name (Legal Business Name): DAVID WAYNE FERGUSON L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 EDISON AVE
SACRAMENTO CA
95821-2421
US

IV. Provider business mailing address

2714 EDISON AVE
SACRAMENTO CA
95821-2421
US

V. Phone/Fax

Practice location:
  • Phone: 801-455-5506
  • Fax:
Mailing address:
  • Phone: 801-455-5506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6046086-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: