Provider Demographics
NPI:1952094583
Name:WILDER, MAEVE ERIN
Entity Type:Individual
Prefix:
First Name:MAEVE
Middle Name:ERIN
Last Name:WILDER
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 1:533 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5619
Mailing Address - Country:US
Mailing Address - Phone:720-768-3763
Mailing Address - Fax:
Practice Address - Street 1:533 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5619
Practice Address - Country:US
Practice Address - Phone:720-768-3763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst