ROGER WILDER

SALEM, OR
NPI1497153076
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OR  13-09-59)
Enumeration Date2014-12-12
Last Update Date2014-12-12
Business Address
-- ROGER WILDER
3871 FAIRVIEW INDUSTRIAL DR SE ST #105
SALEM, OR 97302-1180
Phone number: 503-391-9765
Mailing Address
-- ROGER WILDER
3871 FAIRVIEW INDUSTRIAL DR SE ST #105
SALEM, OR 97302
Phone number: 503-391-9765
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