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| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Susan Marie Wilde | [sources] | |||
| Birth date | not available | [sources] | |||
| Nationality | not available | [sources] | |||
| Country | United States | [sources] | |||
| First name | Susan | [sources] | |||
| Last name | Wilde | [sources] | |||
| Middle name | Marie | [sources] | |||
| Registration number | 19673 · PSY196730 | [sources] | |||
| Sector | Psychologist | [sources] | |||
| Address | 6612 Schmidt Lane, No. 3, El Cerrito, CA, 94530 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.
United States · DHCS
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