Individual
LAQUITTA ANTIONETTE WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
140 WELDON PKWY, MARYLAND HEIGHTS, MO 63043-3102
(314) 417-5075
Mailing address
3117 NORWOOD AVE, SAINT LOUIS, MO 63115-1037
(314) 450-0923
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2019031990
MO
Other
Enumeration date
11/19/2016
Last updated
11/13/2024
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