Individual
ELEANOR KAY WILDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
555 SOQUEL AVE, SUITE 240, SANTA CRUZ, CA 95062-2336
(831) 425-1531
Mailing address
327 ALAMO AVE, SANTA CRUZ, CA 95060-3005
(831) 425-1531
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
Primary
MFC47911
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N2643674
CA DRIVERS LICENSE
—
Enumeration date
08/07/2007
Last updated
06/07/2011
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