Provider Demographics
NPI:1154852507
Name:WADE THOMSON
Entity Type:Organization
Organization Name:WADE THOMSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-493-2100
Mailing Address - Street 1:1363 S STATE ST STE 140
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5540
Mailing Address - Country:US
Mailing Address - Phone:801-493-2100
Mailing Address - Fax:801-493-2103
Practice Address - Street 1:1363 S STATE ST STE 140
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-5540
Practice Address - Country:US
Practice Address - Phone:801-493-2100
Practice Address - Fax:801-493-2103
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPPING STONES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency