Individual
MR. WADE POULSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
145 E 1300 S, SUITE 501, SALT LAKE CITY, UT 84115-5482
(385) 468-3559
(385) 468-3560
Mailing address
145 E 1300 S, SUITE 501, SALT LAKE CITY, UT 84115-5482
(385) 468-3559
(385) 468-3560
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7966792-6004
UT
Other
Enumeration date
02/24/2011
Last updated
07/14/2014
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