Lucy Marden Wild, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD-D-10230579 Issued in OR

Practice address

2705 E Burnside St Ste 206
Portland, OR 97214-1768

Phone

(732) 963-6670

NPI assigned

Feb 25, 2021

Sex

Female

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

Enrolled in OR

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• The Oregon Clinic PC

  • Specialist
  • Portland, OR
  • NPI 1265417174
  Medicare reassignment NPD
• The Oregon Clinic, PC

  • Durable Medical Equipment & Medical Supplies
  • Portland, OR
  • NPI 1346105129
  NPD
• Balance Eating Disorder Center LLC

  • Mental Illness Intermediate Care Facility
  • New York, NY
  • NPI 1467029587
  NPD (past)

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

{
    "created_epoch": "1614211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760054400000",
    "number": "1760076202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 E BURNSIDE ST STE 206",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141768",
            "telephone_number": "732-963-6670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 E BURNSIDE ST STE 206",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141768",
            "telephone_number": "732-963-6670"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1450 Garden St",
            "address_purpose": "LOCATION",
            "city": "Hoboken",
            "state": "NJ",
            "postal_code": "070304595",
            "country_code": "US",
            "telephone_number": "732-963-6670",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILD",
        "first_name": "LUCY",
        "middle_name": "MARDEN",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-25",
        "last_updated": "2025-10-10",
        "certification_date": "2025-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "LD-D-10230579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wild Lilac Child Development Community
• Wild Moss Wellness LLC
• Wild Naturopathic
• Wild Open Being, LLC
• Katherine Versenyi Wild, PHD
• Austen Wilde, LPC
• Darcy Wilde, MSW, LCSW
• Lance Christopher Wilde
• Morgan Wilde
• Rosyln Contessla Wilde, LCSW

• Registered Dietitian in Portland, OR
• Providers in Portland, OR by specialty
• Registered Dietitian in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.