Individual
EDWINA WILDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1722 S GLENSTONE AVE STE TT, SPRINGFIELD, MO 65804-1517
(417) 881-2848
(417) 881-2640
Mailing address
5336 W FARM ROAD 54, WILLARD, MO 65781-8223
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
001832
MO
Other
Enumeration date
12/12/2006
Last updated
07/09/2007
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