Provider Demographics
NPI:1669822391
Name:WOOLSEY, CADE BENJAMIN
Entity type:Individual
Prefix:
First Name:CADE
Middle Name:BENJAMIN
Last Name:WOOLSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 PROSPECTOR AVE STE 201B
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7223
Mailing Address - Country:US
Mailing Address - Phone:951-239-5982
Mailing Address - Fax:
Practice Address - Street 1:1910 PROSPECTOR AVE STE 201B
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7223
Practice Address - Country:US
Practice Address - Phone:951-239-5982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1406033363LP0808X
UT14182194405363LP0808X
CA95060012163W00000X
CA95021215363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse