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NPI Code Detail

MEDICARE: ELLIS J WYLDER MS, NCC

MEDICARE: ELLIS J WYLDER MS, NCC
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
1101YS0200XSchool Counselor10366460OR

General Provider Information

NPI Number : 1649497488
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLIS J WYLDER MS, NCC
Provider Business Mailing Address
First Line : 3083 NE 49TH PL
Second Line :
City : HILLSBORO
State : OR
Zip : 97124-6006
Country : US
Telephone Number : 503-844-1500
Fax Number :
Provider Business Practice Location Address
First Line : 3083 NE 49TH PL
Second Line :
City : HILLSBORO
State : OR
Zip : 97124-6006
Country : US
Telephone Number : 503-844-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2007
Last Update Date : 04/13/2026

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