| Kelly Wilder-willis, Phd Llc | |
|
51 Harrison Ave Red Bank NJ 07701-2333 | |
| (732) 618-4950 | |
| Not Available |
| Full Name | Kelly Wilder-willis, Phd Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 51 Harrison Ave, Red Bank, New Jersey |
| Authorized Official Name and Position | Kelly Elizabeth Wilder-willis (OWNER) |
| Authorized Official Contact | 7326184950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly Wilder-willis, Phd Llc Po Box 8264 Red Bank NJ 07701-8264 Ph: (732) 618-4950 | Kelly Wilder-willis, Phd Llc 51 Harrison Ave Red Bank NJ 07701-2333 Ph: (732) 618-4950 |
| NPI Number | 1508047754 |
|---|---|
| Provider Enumeration Date | 11/15/2007 |
| Last Update Date | 11/15/2007 |
| Medicare PECOS PAC ID | 1153411590 |
|---|---|
| Medicare Enrollment ID | O20071221000213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508047754 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 35SI00446400 (New Jersey) | Primary |
| Provider Name | Kelly Wilder Willis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184642571 PECOS PAC ID: 8224091608 Enrollment ID: I20071029000609 |
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