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General NPI Number Information
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NPI Number | 1336619071
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Entity Type | Individual
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Provider Name | MERCEDES DARLENE WILDER LICSW
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Gender | Female
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Dates
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Enumeration Date | 11/26/2018
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Last Update Date | 12/23/2021
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Provider Practice Location Address
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Address Line | 4001 MAIN ST
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City | VANCOUVER
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State | WA
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Zip | 98663-1887
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Country | US
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Telephone | 360-442-9166
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Fax |
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Provider Business Mailing Address
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Address Line | 7815 NE 167TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98682-1566
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Country | US
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Telephone | 360-442-9166
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC60577828
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW60893814
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License Number State | WA
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