Provider Information for 1770866485
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Mr. TOBIAS ALLEN WILDE Sr. MSW, LICSW
Other Names:Other Name:Mr. TOBIAS WILDESex: Male
NPI: 1770866485
Last Updated: 2024-02-19
Certification Date: 2024-02-19
Certification Date: 2024-02-19
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1770866485 | ||||||||||||
| Enumeration Date | 2011-09-20 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 4422 30TH AVE S APT 309 FARGO, ND 58104-8441 United States Phone: 801-548-8535 | Fax: | ||||||||||||
| Primary Practice Address | 4422 30TH AVE S APT 309 FARGO, ND 58104-8441 United States Phone: 801-548-8535 | Fax: | ||||||||||||
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