Doctor Name: | JENNIFER K WILDER |
NPI Number: | 1093955221 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | C5777 |
Business Practice Address: | 110 Union Belle Blvd Saltillo, MS - 388668107 |
Business Phone Number: | 6628693042 |
Business Fax Number: | 6628693405 |
Mailing Address: | 110 Union Belle Blvd, SALTILLO |
State: | MS |
Postal Code: | 388668107 |
Phone Number: | 6628693042 |
Fax Number: | 6628693405 |
NPI Enumeration Date: | 02/27/2009 |
NPI Last Update Date: | 03/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | C5777 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |