Individual
JENNIFER WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
382 WEST MAIN, DUCHESNE, UT 84021
(435) 738-2040
Mailing address
382 WEST MAIN, PO BOX 318, DUCHESNE, UT 84021
(435) 738-2040
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
284410-3501
UT
Other
Enumeration date
02/02/2010
Last updated
02/02/2010
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