Healthcare Provider Details

I. General information

NPI: 1588275622
Provider Name (Legal Business Name): ERICA WILEY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 WINDMERE DR STE 301
STATE COLLEGE PA
16801-7651
US

IV. Provider business mailing address

1663 HIGHLANDON CT
STATE COLLEGE PA
16801-4356
US

V. Phone/Fax

Practice location:
  • Phone: 814-208-9250
  • Fax: 814-208-9108
Mailing address:
  • Phone: 814-935-9760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: