Healthcare Provider Details

I. General information

NPI: 1629947205
Provider Name (Legal Business Name): THE WILD CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 N METHOW VALLEY HWY
TWISP WA
98856-9002
US

IV. Provider business mailing address

PO BOX 1355
WINTHROP WA
98862-3006
US

V. Phone/Fax

Practice location:
  • Phone: 425-941-4361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHLOE WAHAM
Title or Position: OWNER
Credential: DO
Phone: 425-889-4700