Provider Demographics
NPI:1144217688
Name:WILBERT, JEFFREY ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROBERT
Last Name:WILBERT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3797
Mailing Address - Country:US
Mailing Address - Phone:937-435-1911
Mailing Address - Fax:937-435-9977
Practice Address - Street 1:2717 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:SUITE 218
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3797
Practice Address - Country:US
Practice Address - Phone:937-435-1911
Practice Address - Fax:937-435-9977
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWICP22381Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST