Individual
MR. JUSTIN W WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2517 MLK JR BLVD, EUGENE, OR 97401-5898
(541) 342-4293
(541) 342-4832
Mailing address
1790 W 11TH AVE, EUGENE, OR 97402-3758
(541) 686-2611
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
OR
Other
Enumeration date
09/06/2013
Last updated
09/06/2013
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