Provider Demographics
NPI:1679772248
Name:WILDMAN, ROBERT WILLIAM II (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:WILDMAN
Suffix:II
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 1:3710 GRANT DR
Mailing Address - Street 2:K
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5309
Mailing Address - Country:US
Mailing Address - Phone:775-544-2191
Mailing Address - Fax:775-544-2191
Practice Address - Street 1:3710 GRANT DR
Practice Address - Street 2:K
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5309
Practice Address - Country:US
Practice Address - Phone:775-544-2191
Practice Address - Fax:775-544-2191
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV121103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical