Provider Demographics
NPI:1720038706
Name:DREDGE, WILFORD J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILFORD
Middle Name:J
Last Name:DREDGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5801 FASHION BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6159
Mailing Address - Country:US
Mailing Address - Phone:801-596-0147
Mailing Address - Fax:801-716-4049
Practice Address - Street 1:5801 FASHION BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6159
Practice Address - Country:US
Practice Address - Phone:801-596-0147
Practice Address - Fax:801-716-4049
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT104893-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical