Provider Demographics
NPI:1083943310
Name:WILDER, HEATHER N (PSYD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:N
Last Name:WILDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:ALLEN-WILDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:134 SHARPE ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:WEST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02817
Mailing Address - Country:US
Mailing Address - Phone:401-921-3600
Mailing Address - Fax:937-775-4323
Practice Address - Street 1:134 SHARPE ST
Practice Address - Street 2:UNIT 3
Practice Address - City:WEST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02817
Practice Address - Country:US
Practice Address - Phone:401-921-3600
Practice Address - Fax:937-775-4323
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6617103TC0700X, 103TP2701X, 103T00000X
RIPS01330103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103T00000XBehavioral Health & Social Service ProvidersPsychologist