Provider Demographics
NPI:1730494196
Name:WILDE, KATE J (CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:KATE
Middle Name:J
Last Name:WILDE
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 SAINT GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-3912
Mailing Address - Country:US
Mailing Address - Phone:830-672-7300
Mailing Address - Fax:830-672-7302
Practice Address - Street 1:322 SAINT GEORGE ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629-3912
Practice Address - Country:US
Practice Address - Phone:830-672-7300
Practice Address - Fax:830-672-7302
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105386235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist