Healthcare Provider Details

I. General information

NPI: 1306489497
Provider Name (Legal Business Name): JUSTIN WILBERT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10436 S 1055 W
SOUTH JORDAN UT
84095-1529
US

IV. Provider business mailing address

10436 S 1055 W
SOUTH JORDAN UT
84095-1529
US

V. Phone/Fax

Practice location:
  • Phone: 385-479-5395
  • Fax:
Mailing address:
  • Phone: 385-479-5395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: