Provider Demographics
NPI:1376861716
Name:WILDI, PAULA JOSEPHINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JOSEPHINE
Last Name:WILDI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 FARSON ST
Mailing Address - Street 2:UNIT 105
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-1067
Mailing Address - Country:US
Mailing Address - Phone:740-423-1507
Mailing Address - Fax:740-401-0660
Practice Address - Street 1:723 SUMMERS ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-6022
Practice Address - Country:US
Practice Address - Phone:304-428-5573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVS-1231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist