Individual
BRENDA RENEE WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EIS
Contact information
Practice address
1005 MIDWESTERN PKWY, WICHITA FALLS, TX 76302-2211
(940) 322-0771
(940) 766-4943
Mailing address
1005 MIDWESTERN PKWY, WICHITA FALLS, TX 76302-2211
(940) 322-0771
(940) 766-4943
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1993
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111408402
—
TX
Enumeration date
09/27/2010
Last updated
08/08/2011
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