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General NPI Number Information
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NPI Number | 1629947205
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Entity Type | Organization
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Legal Business Name | THE WILD CLINIC, PLLC
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 309 N METHOW VALLEY HWY
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City | TWISP
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State | WA
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Zip | 98856-9002
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Country | US
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Telephone | 425-941-4361
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1355
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City | WINTHROP
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State | WA
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Zip | 98862-3006
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHLOE WAHAM
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Credential | DO
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Telephone | 425-889-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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