1346664505 NPI number — WILDER THERAPY AND WELLNESS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346664505 NPI number — WILDER THERAPY AND WELLNESS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILDER THERAPY AND WELLNESS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346664505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
134 SHARPE ST
Provider Second Line Business Mailing Address:
UNIT 3
Provider Business Mailing Address City Name:
WEST GREENWICH
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-921-3600
Provider Business Mailing Address Fax Number:
401-712-8659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 SHARPE ST
Provider Second Line Business Practice Location Address:
UNIT 3
Provider Business Practice Location Address City Name:
WEST GREENWICH
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-921-3600
Provider Business Practice Location Address Fax Number:
401-712-8659
Provider Enumeration Date:
02/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WILDER
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST/CO-OWNER
Authorized Official Telephone Number:
401-921-3600

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1083943310 . This is a "INDIVIDUAL NPI- HEATHER WILDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1891125167 . This is a "INDIVIDUAL NPI- JAMI WILDER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com