Provider Demographics
NPI:1184342495
Name:WILDER, LINDA (LPC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WILDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LIN
Other - Middle Name:
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:4318 SUMAC LN
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8207
Mailing Address - Country:US
Mailing Address - Phone:970-217-3490
Mailing Address - Fax:
Practice Address - Street 1:4318 SUMAC LN
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8207
Practice Address - Country:US
Practice Address - Phone:360-389-3283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMX61344486101YP2500X
COLPC.0003682101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional