Provider Demographics
NPI:1184838666
Name:WILDWIND, LANDRY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LANDRY
Middle Name:
Last Name:WILDWIND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 BUENA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-2017
Mailing Address - Country:US
Mailing Address - Phone:510-841-1551
Mailing Address - Fax:510-841-1819
Practice Address - Street 1:2901 BUENA VISTA WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94708-2017
Practice Address - Country:US
Practice Address - Phone:510-841-1551
Practice Address - Fax:510-841-1819
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS0077271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical