Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | P1981 | TN |
NPI | 1043233844 |
---|---|
Provider Name | Dr. Julie J Wildman |
First Address | Seaside, CA 93955-7200 |
Second Address | Seaside, CA 93955-7200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 24/12/2007 |