Individual
KATHLEEN WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6375 W CHARLESTON BLVD, STE A100, LAS VEGAS, NV 89146-1139
(702) 253-0818
(702) 253-9625
Mailing address
3016 W CHARLESTON BLVD STE 100, LAS VEGAS, NV 89102-1973
(206) 734-5445
(702) 895-4014
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5457 C
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100507624
—
NV
Enumeration date
05/19/2006
Last updated
05/14/2021
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