Provider Demographics
NPI:1861021404
Name:WILDER, KIMBERLY FRANCINE I
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:FRANCINE
Last Name:WILDER
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-2731
Mailing Address - Country:US
Mailing Address - Phone:216-956-9025
Mailing Address - Fax:
Practice Address - Street 1:6719 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-2731
Practice Address - Country:US
Practice Address - Phone:216-956-9025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist