Individual
MR. JASON EDWARD WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1360 E 1450 S, CLEARFIELD, UT 84015-1611
(801) 773-0712
(801) 774-8267
Mailing address
1360 E 1450 S, CLEARFIELD, UT 84015-1611
(801) 773-0712
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5638133-6004
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260022408
RAILROAD MEDICARE
UT
05
—
876000308007
—
UT
Enumeration date
07/19/2011
Last updated
07/19/2011
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