John Mullane Wild, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

01407C Issued in NV

Practice address

6161 W Charleston Blvd
BLDG. 3a MCT
Las Vegas, NV 89146-1126

Phone

(702) 498-5955

Fax

(702) 486-5755

NPI assigned

Dec 15, 2010

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1292371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292371200000",
    "number": "1629371562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6161 W CHARLESTON BLVD",
            "address_2": "BLDG. 3A MCT",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891461126",
            "telephone_number": "702-498-5955",
            "fax_number": "702-486-5755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6161 W CHARLESTON BLVD",
            "address_2": "BLDG. 3A MCT",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891461126",
            "telephone_number": "702-498-5955",
            "fax_number": "702-486-5755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "JOHN",
        "middle_name": "MULLANE",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-15",
        "last_updated": "2010-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "01407C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill Wilcox
• Simmon L Wilcox, MD
• Tyler Marsh Wilcox
• Valerie Howard Wilcox
• Zach Wilcox
• Kathleen Wild, LCSW
• Tammy M Wild
• Herbert Wilde
• Laura E. Wilde, SLP
• Monique Wildenstein

• Clinical Social Worker in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Clinical Social Worker in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2010; 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.