Conner Randy Wild, SAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

18164-130 Issued in WI

Practice address

122 E Olin Ave Ste 275
Madison, WI 53713-1475

Phone

(608) 228-0079

Fax

(608) 263-9045

NPI assigned

Nov 25, 2019

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1574640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574640000000",
    "number": "1699311670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 E OLIN AVE STE 275",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537131475",
            "telephone_number": "608-228-0079",
            "fax_number": "608-263-9045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 E OLIN AVE STE 275",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537131475",
            "telephone_number": "608-228-0079",
            "fax_number": "608-263-9045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "CONNER",
        "middle_name": "RANDY",
        "name_prefix": "Mr.",
        "credential": "SAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-25",
        "last_updated": "2019-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "18164-130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret C Wilcots, M.D.
• Andrew James Wilcox, PHARMD
• Cassandra Riccioli Wilcox, MS, OTR/L
• Maureen K Wild Gordon, NP
• Wild Meadows Therapy LLC
• Jonathon E. Wild
• Nancy K Wild, NP
• Alexander Wilde, DPT
• Bailey Wilde
• Christoher Wilde, PEDORTHIST

• Addiction (Substance Use Disorder) Counselor in Madison, WI
• Providers in Madison, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 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.