Healthcare Provider Details

I. General information

NPI: 1750989919
Provider Name (Legal Business Name): ERIN J WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2020
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E FORT UNION BLVD STE 135
MIDVALE UT
84047-1531
US

IV. Provider business mailing address

11072 S ROCHESTER AVE APT 2554
SOUTH JORDAN UT
84095-4206
US

V. Phone/Fax

Practice location:
  • Phone: 801-603-2547
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12288162-3501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

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: