Provider Demographics
NPI:1639184484
Name:WILDE, SHERYL KAY (LPC)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:KAY
Last Name:WILDE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5034 MUND RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66218-9147
Mailing Address - Country:US
Mailing Address - Phone:913-422-8477
Mailing Address - Fax:913-322-4562
Practice Address - Street 1:5034 MUND RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66218-9147
Practice Address - Country:US
Practice Address - Phone:913-422-8477
Practice Address - Fax:913-322-4562
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS928101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional