Provider Demographics
NPI:1659248821
Name:WILDER ACADEMY OF VIRTUAL EDUCATION
Entity type:Organization
Organization Name:WILDER ACADEMY OF VIRTUAL EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPED DIRECTOR / VICE PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAUBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:EDS,MA
Authorized Official - Phone:986-256-7220
Mailing Address - Street 1:419 HUFF RD
Mailing Address - Street 2:
Mailing Address - City:WILDER
Mailing Address - State:ID
Mailing Address - Zip Code:83676-5003
Mailing Address - Country:US
Mailing Address - Phone:203-337-7400
Mailing Address - Fax:
Practice Address - Street 1:419 HUFF RD
Practice Address - Street 2:
Practice Address - City:WILDER
Practice Address - State:ID
Practice Address - Zip Code:83676-5003
Practice Address - Country:US
Practice Address - Phone:203-337-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILDER SCHOOL DISTRICT 133
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-21
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty