Provider Demographics
NPI:1467423327
Name:WILSON, RUTH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 E BIG PINE DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-7222
Mailing Address - Country:US
Mailing Address - Phone:801-566-3093
Mailing Address - Fax:
Practice Address - Street 1:51 W 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1431
Practice Address - Country:US
Practice Address - Phone:801-587-2377
Practice Address - Fax:801-581-6259
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT107144-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU002Medicare UPIN
UTU003Medicare UPIN
UTU006Medicare UPIN