MEDICARE: LAUREN 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	13402714-3501	UT

General Provider Information

NPI Number	:	1831664341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN WILDE

Provider Business Mailing Address
First Line	:	9071 S 1300 W STE 205
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-6725
Country	:	US
Telephone Number	:	801-453-9625
Fax Number	:	801-944-7347

Provider Business Practice Location Address
First Line	:	9071 S 1300 W STE 205
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-6725
Country	:	US
Telephone Number	:	801-453-9625
Fax Number	:	801-944-7347

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

Provider Enumeration Date	:	10/11/2018
Last Update Date	:	06/24/2025

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Directions to “ LAUREN WILDE ” Practice Location

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