Willow Nichole Wilde, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L17959 Issued in OR

Practice address

1238 S 58TH St
Springfield, OR 97478-5474

Phone

(541) 698-1805

NPI assigned

Oct 2, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mindful Therapy Group PCGroup PAC ID 4981872561, 654 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mindful Therapy Group PC

  • Clinical Social Worker
  • Mountlake Terrace, WA
  • NPI 1316238678

  OR

  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1696204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777507200000",
    "number": "1205616018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1238 S 58TH ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974785474",
            "telephone_number": "541-698-1805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1238 S 58TH ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974785474",
            "telephone_number": "541-698-1805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDE",
        "first_name": "WILLOW",
        "middle_name": "NICHOLE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-02",
        "last_updated": "2026-04-30",
        "certification_date": "2026-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L17959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Akiva Wickramaratna
• Cassie Colleen Widdison
• Rebekah Shea Wieland, MD
• Laura Marie Wiese, CNM
• Kevin Sean Wilbanks, M.A.
• Stephanie Kresch Wilder, M.D.
• Wren A Wilder
• Wildflower Integrative Medicine
• Steven L Wilhite, M..D.
• Kathleen E Wilken, M.D.

• Clinical Social Worker in Springfield, OR
• Providers in Springfield, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.