Healthcare Provider Details

I. General information

NPI: 1316765126
Provider Name (Legal Business Name): WISE SAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 E 900 S
SALT LAKE CITY UT
84111-4251
US

IV. Provider business mailing address

1280 E LORRAINE DR
SALT LAKE CITY UT
84106-2511
US

V. Phone/Fax

Practice location:
  • Phone: 216-409-6814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: LAUREN MORIARTY
Title or Position: OWNER
Credential: LCSW
Phone: 216-409-6814