MR. CONNER RANDY WILD (NPI# 1699311670) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699311670 |
| Entity Type | Individual |
| Full Name | MR. CONNER RANDY WILD |
| Credential | SAC |
| Practice Address |
122 E Olin Ave Ste 275 Madison WI 53713-1475 |
| Practice Telephone | 6082280079 |
| Practice Fax Number | 6082639045 |
| Mailing Telephone | 6082280079 |
| Mailing Fax Number | 6082639045 |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2019-11-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
18164-130 | WI | Behavioral Health & Social Service Providers |
| Street Address |
122 E OLIN AVE STE 275 |
| City | MADISON |
| State | WI |
| Zip Code | 53713-1475 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629326103 | Molly Hall Ripley | Marriage & Family Therapist | 122 E Olin Ave Ste 275, Madison, WI 53713 | 2012-08-15 |
| 1902441116 | Nicholas Paul Utter | Social Worker | 122 E Olin Ave Ste 275, Madison, WI 53713-1475 | 2019-11-12 |
| 1174168389 | Nora S Burnham | Social Worker | 122 E Olin Ave Ste 275, Madison, WI 53713-1475 | 2019-11-12 |
| 1821640202 | Jessica Corroo | Counselor | 122 E Olin Ave Ste 275, Madison, WI 53713-1475 | 2019-07-15 |
| 1437678299 | Bret Schluederberg | Counselor | 122 E Olin Ave Ste 275, Madison, WI 53713-1475 | 2017-09-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508406760 | Diana Kay Woodruff | Registered Nurse | Madison West Comprehensive Treatment Center, 151 E. Badger Rd. Suite A, Madison, WI 53713 | 2020-01-15 |
| 1568008886 | Avery Reven Kansteiner | Counselor | 105 Ski Court, Madison, WI 53713 | 2019-11-21 |
| 1518501329 | Erica D Anderson | Counselor | 1125 W Badger Rd Apt 6, Madison, WI 53713 | 2019-11-05 |
| 1942799739 | Emily Natera | Counselor | 128 E. Olin Ave., Ste. 100, Madison, WI 53713 | 2018-05-07 |
| 1295255644 | Renee Denise Wilberg | Counselor | 122 E. Olin Avenue, Madison, WI 53713 | 2017-06-26 |
| 1548793060 | Racquel Williams-kroll | Registered Nurse | 151 East Badger Road Ste A, Madison, WI 53713 | 2017-04-11 |
| 1124570841 | Shirley Norman-johnson | Licensed Practical Nurse | 115 East Badger Rd, Suite A, Madison, WI 53713 | 2016-10-28 |
| 1629525613 | Katherine Simons Melde | Nurse Practitioner | 2222 S Park St Ste 210, Madison, WI 53713 | 2016-09-07 |
| 1013301779 | Bio-medical Applications of Wisconsin, Inc. | Clinic/Center | 2840 Index Rd., Madison, WI 53713 | 2015-03-20 |
| 1902147721 | Jill Zimmerman | Occupational Therapy Assistant | 2801 Coho Street, Suite 300, Madison, WI 53713 | 2013-03-04 |
| Find all providers in zip 53713 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396359337 | Sarah Luetzow Marten | Counselor | 6441 Enterprise Ln Ste 101, Madison, WI 53719-1180 | 2020-09-08 |
| 1366051088 | Katreasa L Cwright | Counselor | 224 South 5th St, Madison, AR 72359 | 2020-07-28 |
| 1811522253 | Sandra Bruno | Counselor | 102 Wesly Clark Blvd, Madison, AL 35756-4028 | 2020-03-05 |
| 1750915047 | Marina Macgillivray | Counselor | 2009 E Dayton St, Madison, WI 53704-4720 | 2020-02-26 |
| 1518501329 | Erica D Anderson | Counselor | 1125 W Badger Rd Apt 6, Madison, WI 53713 | 2019-11-05 |
| 1851954713 | Michael Allen Hetts | Counselor | Madison East Ctc, 5109 World Dairy Dr, Madison, WI 53718-3807 | 2019-04-17 |
| 1205333671 | Michele Lee Nusker | Counselor | 1733 Stirling Rd, Madison, OH 44057-2030 | 2018-04-11 |
| 1609378546 | Impact Behavioral Counseling LLC | Counselor | 20 Hughes Rd Ste 101-b, Madison, AL 35758-2237 | 2018-03-07 |
| 1295255644 | Renee Denise Wilberg | Counselor | 122 E. Olin Avenue, Madison, WI 53713 | 2017-06-26 |
| 1669837498 | Gregory Cox | Counselor | 313 Price Pl Ste 101, Madison, WI 53705-3262 | 2015-12-21 |
| Find all providers in MADISON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.