Individual
BONITA JO WILDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CAC III
Contact information
Practice address
421 S TEJON ST STE 100, COLORADO SPRINGS, CO 80903-2139
(719) 308-5450
Mailing address
208 STEVEN DR, COLORADO SPRINGS, CO 80911-1554
(719) 528-3500
(719) 528-2433
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACC.0005334
CO
Other
Enumeration date
11/22/2016
Last updated
05/06/2024
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