Individual
JACK WILDWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
133 GALLERY LN, MORRISVILLE, VT 05661-9057
(802) 505-9044
Mailing address
PO BOX 287, HYDE PARK, VT 05655-0287
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
097.0135245
VT
Other
Enumeration date
08/22/2018
Last updated
12/17/2025
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