Healthcare Provider Details

I. General information

NPI: 1083943310
Provider Name (Legal Business Name): HEATHER N WILDER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER NICOLE ALLEN-WILDER PSY.D.

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 08/25/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 SHARPE ST UNIT 3
WEST GREENWICH RI
02817
US

IV. Provider business mailing address

134 SHARPE ST UNIT 3
WEST GREENWICH RI
02817
US

V. Phone/Fax

Practice location:
  • Phone: 401-921-3600
  • Fax: 937-775-4323
Mailing address:
  • Phone: 401-921-3600
  • Fax: 937-775-4323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6617
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6617
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS01330
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number6617
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: