Individual
DAVID JONATHAN WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMHC
Contact information
Practice address
10038 S COUNTRYWOOD DR, SANDY, UT 84092
(801) 783-3853
Mailing address
10038 S COUNTRYWOOD DR, SANDY, UT 84092-3747
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4925801-6009
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260022408
RAILROAD MEDICARE
UT
05
—
876000308007
—
UT
Enumeration date
07/21/2010
Last updated
05/30/2018
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