Individual
KATHERINE VERSENYI WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7772
Mailing address
626 NE MIRIMAR PL, PORTLAND, OR 97232-2541
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1058
OR
103TC0700X
Clinical Psychologist
Primary
1058
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117965
—
OR
Enumeration date
08/01/2006
Last updated
03/22/2010
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