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General NPI Number Information
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NPI Number | 1700687415
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Entity Type | Individual
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Provider Name | WALTER ELDRIDGE WRIGHT III SOCIAL WORKER
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Gender | Male
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 4905 S 900 E
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City | MURRAY
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State | UT
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Zip | 84117-5703
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Country | US
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Telephone | 801-869-1095
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Fax |
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Provider Business Mailing Address
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Address Line | 3214 PINGREE AVE
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City | OGDEN
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State | UT
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Zip | 84401-3805
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Country | US
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Telephone | 801-678-7176
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 7062219-3502
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License Number State | UT
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