Healthcare Provider Details

I. General information

NPI: 1326708355
Provider Name (Legal Business Name): DELANY WILDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date: 03/24/2026
Reactivation Date: 03/31/2026

III. Provider practice location address

114 JUNEFIELD AVE
CINCINNATI OH
45218-1200
US

IV. Provider business mailing address

118 JUNEFIELD AVE
CINCINNATI OH
45218-1200
US

V. Phone/Fax

Practice location:
  • Phone: 907-947-4164
  • Fax:
Mailing address:
  • Phone: 907-947-4164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2607831
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: