Wilde, Willow Nichole
Wilde, Willow Nichole is an sole proprietor health care provider with primary practice located at 28312 Mateer Rd , Gold Beach OR 97444-9650. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Wilde, Willow Nichole can be contacted via phone (541) 698-1805.Contact Information
Primary practice address
28312 Mateer Rd
Gold Beach OR 97444-9650
Phone: (541) 698-1805
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | ||
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | A14739 | Oregon |
Profile Details
| NPI number | 1205616018 |
|---|---|
| LBN Legal business name | Wilde, Willow Nichole |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 2nd, 2023 |
| Last updated | Feb 29th, 2024 - about 7 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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