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General NPI Number Information
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NPI Number | 1801669007
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Entity Type | Individual
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Provider Name | BRENDA JOY WILKIE
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Gender | Female
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Dates
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Enumeration Date | 10/31/2023
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 38300 WENDLING RD
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City | MARCOLA
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State | OR
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Zip | 97454-9732
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Country | US
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Telephone | 775-340-2925
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Fax |
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Provider Business Mailing Address
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Address Line | 91375 MARCOLA RD
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City | SPRINGFIELD
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State | OR
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Zip | 97478-8707
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Country | US
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Telephone | 775-340-2925
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 519017
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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