Provider Demographics
NPI:1669061057
Name:WILDNER, KARI JOY (LCSW)
Entity type:Individual
Prefix:MS
First Name:KARI
Middle Name:JOY
Last Name:WILDNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KARI
Other - Middle Name:JOY
Other - Last Name:WILDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KARI JOY JOHNSON
Mailing Address - Street 1:1515 JO FRAN DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-8781
Mailing Address - Country:US
Mailing Address - Phone:269-271-2216
Mailing Address - Fax:
Practice Address - Street 1:800 E MILHAM AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1490
Practice Address - Country:US
Practice Address - Phone:269-249-7179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010961341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical