Healthcare Provider Details

I. General information

NPI: 1306425152
Provider Name (Legal Business Name): ANGELA WIGNALL SCHULTZ LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 W 710 S
LOGAN UT
84321-6050
US

IV. Provider business mailing address

1246 W 710 S
LOGAN UT
84321-6050
US

V. Phone/Fax

Practice location:
  • Phone: 541-625-0028
  • Fax:
Mailing address:
  • Phone: 541-625-0028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTPSW5213
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09931656
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number365340-3501
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW04396
License Number StateRI
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9871068
License Number StateID
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9871068
License Number StateID
# 7
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1140554
License Number StateMA

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: