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General NPI Number Information
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NPI Number | 1528913134
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Entity Type | Organization
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Legal Business Name | WILDE THERAPY
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Dates
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Enumeration Date | 02/27/2026
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 2568 WASHINGTON BLVD STE 200
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City | OGDEN
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State | UT
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Zip | 84401-3114
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Country | US
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Telephone | 801-644-1456
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Fax |
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Provider Business Mailing Address
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Address Line | 2879 VIRGINIA WAY
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City | OGDEN
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State | UT
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Zip | 84403-0452
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Country | US
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Telephone | 801-644-1456
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CRAIG WILDE
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Credential | LCSW
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Telephone | 801-644-1456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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