Provider Demographics
NPI:1831715515
Name:WUTHRICH, ERIN (SSW)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:
Last Name:WUTHRICH
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 WASHINGTON BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-3606
Mailing Address - Country:US
Mailing Address - Phone:801-621-8670
Mailing Address - Fax:
Practice Address - Street 1:2661 WASHINGTON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-3606
Practice Address - Country:US
Practice Address - Phone:801-621-8670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT328446-3503104100000X
UT261703236171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker