Individual
AMY M WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ACMHC, LSUDC
Contact information
Practice address
20 S STATE ST, LINDON, UT 84042-1939
(801) 441-7144
Mailing address
10442 S SAGE CREEK RD, SOUTH JORDAN, UT 84009-3909
(801) 637-9771
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
302808-6006
UT
101YM0800X
Mental Health Counselor
Primary
302808-6009
UT
Other
Enumeration date
01/11/2018
Last updated
01/11/2018
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