Individual
ATHENA LEEANN WILDENBORG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
T-23-2498
Contact information
Practice address
200 LA LOMA CT, ROSEVILLE, CA 95678-2908
(360) 214-4102
Mailing address
1122 NE 122ND AVE STE A102, PORTLAND, OR 97230-2082
(503) 954-1890
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
T-23-2498
OR
Other
Enumeration date
11/09/2023
Last updated
11/09/2023
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