Individual
ROSYLN CONTESSLA WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
9054 N NEW YORK AVE, PORTLAND, OR 97203-3036
(971) 412-2620
Mailing address
9054 N NEW YORK AVE, PORTLAND, OR 97203-3036
(503) 462-4440
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L11114
OR
Other
Enumeration date
03/31/2022
Last updated
11/08/2022
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