Provider Demographics
NPI:1740893452
Name:WILDER, AARON R
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:R
Last Name:WILDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 ROAD I.3 NE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-8845
Mailing Address - Country:US
Mailing Address - Phone:208-290-3466
Mailing Address - Fax:
Practice Address - Street 1:615 S DIVISION ST STE A
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-3800
Practice Address - Country:US
Practice Address - Phone:509-764-6644
Practice Address - Fax:509-764-6676
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician