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NPI Code Detail

MEDICARE: CARI GWENDOLYN WILD

MEDICARE: CARI GWENDOLYN WILD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor11988-125WI

General Provider Information

NPI Number : 1023666047
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARI GWENDOLYN WILD
Provider Business Mailing Address
First Line : W9124 SAWMILL RD
Second Line :
City : BLANCHARDVILLE
State : WI
Zip : 53516-9603
Country : US
Telephone Number : 608-558-8823
Fax Number :
Provider Business Practice Location Address
First Line : 610 N BROADWAY
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-3426
Country : US
Telephone Number : 920-437-7206
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2019
Last Update Date : 11/07/2025

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