Healthcare Provider Details

I. General information

NPI: 1285230516
Provider Name (Legal Business Name): MICHAEL JARED WARDE CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 E 200 N
LOGAN UT
84321-4034
US

IV. Provider business mailing address

195 S 1130 E
HYRUM UT
84319-1130
US

V. Phone/Fax

Practice location:
  • Phone: 435-792-6500
  • Fax:
Mailing address:
  • Phone: 435-713-5152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11919342-3502
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: