Individual
DAWN L WYLDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN/QMHP-C
Contact information
Practice address
17645 NW SAINT HELENS RD, PORTLAND, OR 97231-1729
(503) 621-1069
(503) 621-0200
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
23-QMHPC-001204
OR
163W00000X
Registered Nurse
Primary
201401462RN
OR
163W00000X
Registered Nurse
RN60392843
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2075923
—
WA
05
—
500798396
—
OR
Enumeration date
12/30/2015
Last updated
04/27/2023
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