Provider Demographics
NPI:1952657470
Name:WILDONGER, EVANGELINE
Entity Type:Individual
Prefix:MRS
First Name:EVANGELINE
Middle Name:
Last Name:WILDONGER
Suffix:
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 1:995 DOYLESTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-2816
Mailing Address - Country:US
Mailing Address - Phone:215-536-7800
Mailing Address - Fax:
Practice Address - Street 1:995 DOYLESTOWN PIKE
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-2816
Practice Address - Country:US
Practice Address - Phone:215-536-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007054235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist