MEDICARE: MERCEDES DARLENE WILDER LICSW

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
1	1041C0700X	Clinical Social Worker	L8378	OR
2	1041C0700X	Clinical Social Worker	SC60577828	WA
3	1041C0700X	Clinical Social Worker	LW60893814	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336619071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERCEDES DARLENE WILDER LICSW

Provider Business Mailing Address
First Line	:	500 NE MULTNOMAH ST STE 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2031
Country	:	US
Telephone Number	:	800-813-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 7TH AVE
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-3198
Country	:	US
Telephone Number	:	800-813-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	03/23/2026

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