MEDICARE: CAMI JO WILDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1144005919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMI JO WILDE

Provider Business Mailing Address
First Line	:	2550 WASHINGTON BLVD STE 300
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84401-3121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 WASHINGTON BLVD STE 200
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84401-3121
Country	:	US
Telephone Number	:	801-621-4512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	08/29/2023

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Directions to “ CAMI JO WILDE ” Practice Location

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