Individual
MR. CONNER RANDY WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SAC
Contact information
Practice address
122 E OLIN AVE STE 275, MADISON, WI 53713-1475
(608) 228-0079
(608) 263-9045
Mailing address
122 E OLIN AVE STE 275, MADISON, WI 53713-1475
(608) 228-0079
(608) 263-9045
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18164-130
WI
Other
Enumeration date
11/25/2019
Last updated
11/25/2019
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