Doctor Name: | KATHLEEN WILDE |
NPI Number: | 1700131265 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. |
License Number: | |
Business Practice Address: | 120 S Main St Heppner, OR - 978362033 |
Business Phone Number: | 5416769161 |
Business Fax Number: | 5416765662 |
Mailing Address: | Po Box 469, HEPPNER |
State: | OR |
Postal Code: | 978360469 |
Phone Number: | 5416769161 |
Fax Number: | 5416765662 |
NPI Enumeration Date: | 07/19/2012 |
NPI Last Update Date: | 07/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |