Provider Demographics
NPI:1508843467
Name:MILNE, WADE OSMOND (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WADE
Middle Name:OSMOND
Last Name:MILNE
Suffix:
Gender:M
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1054 E RIVERSIDE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4825
Practice Address - Country:US
Practice Address - Phone:435-634-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT373795-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000063902Medicare PIN