Individual
MRS. SONJA ANN WILDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADC I
Contact information
Practice address
3647 HIGHWAY 39, KLAMATH FALLS, OR 97603-2612
(541) 884-5244
(541) 884-1105
Mailing address
3647 HIGHWAY 39, KLAMATH FALLS, OR 97603-2612
(541) 884-5244
(541) 884-1105
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
06-11-52
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136460
—
OR
Enumeration date
02/24/2011
Last updated
08/31/2016
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