| NPI | 1700131265 |
|---|---|
| Former Name | KATHLEEN WILDE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C3623) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2023-09-06 |