Basic Information
| Provider Information | |||||||||
| NPI: | 1376861716 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILDI | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | JOSEPHINE | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 809 FARSON ST | ||||||||
| Address2: | UNIT 105 | ||||||||
| City: | BELPRE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457141067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404231507 | ||||||||
| FaxNumber: | 7404010660 | ||||||||
| Practice Location | |||||||||
| Address1: | 723 SUMMERS ST | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261016022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044285573 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2010 | ||||||||
| LastUpdateDate: | 01/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | S-1231 | WV | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.