Provider Demographics
NPI:1134197940
Name:WILCOX, MICHELLE CHRISTINE (LCSW, LASUDC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:LCSW, LASUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 E SOUTH UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2302
Mailing Address - Country:US
Mailing Address - Phone:385-235-6926
Mailing Address - Fax:801-255-7284
Practice Address - Street 1:940 E SOUTH UNION AVE
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2302
Practice Address - Country:US
Practice Address - Phone:385-235-6926
Practice Address - Fax:801-255-7284
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT270969-6008101YA0400X
UT270969-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT788007788032Medicaid