Individual
MR. MICAH ALDEN WYLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SLP
Contact information
Practice address
3720 N CLAREY ST, EUGENE, OR 97402-8744
(458) 201-4936
Mailing address
1185 FIR ACRES DR, EUGENE, OR 97401-1884
(310) 666-8623
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
17838
OR
Other
Enumeration date
08/21/2024
Last updated
08/21/2024
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