Provider Demographics
NPI:1891798419
Name:WILDER, KATHRYN V (AUD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:V
Last Name:WILDER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 FOREST HILL BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5878
Mailing Address - Country:US
Mailing Address - Phone:561-649-4006
Mailing Address - Fax:561-969-6621
Practice Address - Street 1:3540 FOREST HILL BLVD
Practice Address - Street 2:STE 205
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5878
Practice Address - Country:US
Practice Address - Phone:561-649-4006
Practice Address - Fax:561-969-6621
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY338231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600035500Medicaid
FL640001185OtherRAILROAD MEDICARE
FLS1037OtherBCBS
FL600035507Medicaid
FL600037100Medicaid
FL600035508Medicaid
FL600035500Medicaid
FL600037100Medicaid