Provider Demographics
NPI:1144716168
Name:WILDER, CHRISTEL (MS)
Entity type:Individual
Prefix:
First Name:CHRISTEL
Middle Name:
Last Name:WILDER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CHRISTEL
Other - Middle Name:
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:7214 PERRY AVE SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-7714
Mailing Address - Country:US
Mailing Address - Phone:254-368-1675
Mailing Address - Fax:
Practice Address - Street 1:621 PACIFIC AVE STE 17
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4699
Practice Address - Country:US
Practice Address - Phone:254-368-1675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61229646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist