EDWINA WILDER (NPI# 1417018904) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417018904 |
| Entity Type | Individual |
| Full Name | EDWINA WILDER |
| Credential | LPC |
| Practice Address |
1722 S Glenstone Ave Ste Tt Springfield MO 65804-1517 |
| Mailing Address |
5336 W Farm Road 54 Willard MO 65781-8223 |
| Practice Telephone | 4178812848 |
| Practice Fax Number | 4178812640 |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
001832 | MO | Behavioral Health & Social Service Providers |
| Street Address |
1722 S GLENSTONE AVE STE TT |
| City | SPRINGFIELD |
| State | MO |
| Zip Code | 65804-1517 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508934571 | Elizabeth Bales | Counselor | 1722 S Glenstone Ave Ste Tt, Springfield, MO 65804-1517 | 2006-11-30 |
| 1558439521 | Diane F. Davis | Counselor | 1722 S Glenstone Ave Ste Tt, Springfield, MO 65804-1517 | 2006-11-30 |
| 1598833576 | Karen Davis | Counselor | 1722 S Glenstone Ave Ste Tt, Springfield, MO 65804-1517 | 2006-11-30 |
| 1295803278 | Brenda Grass | Counselor | 1722 S Glenstone Ave Ste Tt, Springfield, MO 65804-1517 | 2006-11-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790393049 | Kathy Forson | Nurse Practitioner | 1235 E. Cherokee St., Springfield, MO 65804 | 2020-07-22 |
| 1306498779 | Anne B Summers, LLC | Social Worker | 1310 E. Kingsley St., Ste C, Springfield, MO 65804 | 2019-07-15 |
| 1790241800 | Margaret Mary Hart | Social Worker | 1845 S Rogers Ave, Springfield, MO 65804 | 2019-02-13 |
| 1598254666 | Casey Carr | Optometrist | 1229 E Seminole St Ste 110, Springfield, MO 65804 | 2018-05-04 |
| 1124520697 | Shelby D White | Behavioral Analyst | 1300 E. Bradford Parkway, Springfield, MO 65804 | 2018-03-01 |
| 1316448343 | Karl Lynham | Massage Therapist | 1200 E Woodhurst Dr R300, Springfield, MO 65804 | 2018-02-25 |
| 1699273763 | Leah Wilson | Counselor | 1322 E Woodgate, Springfield, MO 65804 | 2018-01-24 |
| 1295242626 | Matthew Crisp | Physical Therapist | 3252 E Independence St, Springfield, MO 65804 | 2018-01-08 |
| 1518491042 | Crystal Spangler | Dietitian, Registered | 1965 S Fremont Ave Ste 220, Springfield, MO 65804 | 2017-04-11 |
| 1588012033 | Jeffrey Williams | Pharmacist | 1235 E. Cherokee, Springfield, MO 65804 | 2016-05-25 |
| Find all providers in zip 65804 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578161964 | Joyful Living Behavioral Health Inc | Counselor | 107 W Q St, Springfield, OR 97477-2171 | 2020-10-16 |
| 1366055352 | Joshua Dauner | Counselor | 819 N Boonville Ave, Springfield, MO 65802-3831 | 2020-08-28 |
| 1972114411 | Doris Osiimwe Johnson | Counselor | 52 Elaine Cir # 52, Springfield, MA 01109-1205 | 2020-08-10 |
| 1003426610 | Jy Counseling LLC | Counselor | 6054 Forrest Hollow Ln, Springfield, VA 22152-1428 | 2020-08-07 |
| 1912526674 | Amy Christine Russell | Counselor | 317 30th St Apt 304d, Springfield, OR 97478-7619 | 2020-04-13 |
| 1588299184 | Julie Patricia Slover | Counselor | 3331 S Parkview Ave, Springfield, MO 65804-4755 | 2020-03-04 |
| 1356986319 | Three Dirty Birds LLC | Counselor | 805 Lorraine Dr, Springfield, PA 19064-1004 | 2019-11-14 |
| 1992348916 | Tiffany Looney | Counselor | 1705 Centennial Blvd Ste 1, Springfield, OR 97477-3320 | 2019-10-22 |
| 1588206346 | Carrie Stormzand | Counselor | 4546 S Quail Creek Ave, Springfield, MO 65810-1678 | 2019-10-14 |
| 1366084295 | Betty Jean | Counselor | 673 Morris Ave, Springfield, NJ 07081-1512 | 2019-10-11 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 65804 |
Please comment or provide details below to improve the information on EDWINA WILDER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.