| Doctor Name: | MRS. ADRIENNE KATHERINE WILDE |
| NPI Number: | 1336281104 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, CCC SLP |
| License Number: | 117608 |
| Business Practice Address: | 1432 Southwest Blvd Jefferson City, MO - 651092444 |
| Business Phone Number: | 5736325633 |
| Business Fax Number: | 5376325990 |
| Mailing Address: | 5521 Dove Lake Rd, JEFFERSON CITY |
| State: | MO |
| Postal Code: | 651019328 |
| Phone Number: | 5732914646 |
| Fax Number: | 5736325990 |
| NPI Enumeration Date: | 02/12/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 117608 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |