Kaseja Laurine Wilder, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

575 Kingswood Ave
Eugene, OR 97405

Phone

(541) 844-5038

NPI assigned

Oct 25, 2013

Reactivated

May 22, 2019

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

Other identifiers 1

Other names 1

• Margaret Laurine Nebergall Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Kaseja Wilder LLC

  • Clinical Social Worker
  • Eugene, OR
  • NPI 1164996294
  NPD (past) Authorized official

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

{
    "created_epoch": "1382659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558483200000",
    "number": "1326476565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1292 HIGH ST #160",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "97401",
            "telephone_number": "541-844-5038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 KINGSWOOD AVE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "97405",
            "telephone_number": "541-844-5038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "KASEJA",
        "middle_name": "LAURINE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-25",
        "last_updated": "2019-05-22",
        "deactivation_date": "2019-01-12",
        "reactivation_date": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019047",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARGARET",
            "last_name": "NEBERGALL",
            "middle_name": "LAURINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Karen Marie Wilbrecht
• Kara Noel Wilcox, PA-C
• Wild Rose Medical Clinic PC
• Justin W Wilde
• Eryn Grace Wilder
• Kestrel Wilder, LMT
• Payton Wilder
• Francis Reign Wildheart, CPM, LDM
• Khiara Wildman, CRM
• Cherie Marcel Wiles-Pearson, RDN

• Mental Health Counselor in Eugene, OR
• Providers in Eugene, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.