MEDICARE: MRS. ALYSSA RENEE 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
1	106S00000X	Behavior Technician	RBT-18-65938	CA
2	1041C0700X	Clinical Social Worker
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1750866695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALYSSA RENEE WILD

Provider Business Mailing Address
First Line	:	7001 EAST PKWY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 EAST PKWY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2501
Country	:	US
Telephone Number	:	916-875-5881
Fax Number	:

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

Provider Enumeration Date	:	09/26/2018
Last Update Date	:	02/16/2026

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