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General NPI Number Information
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NPI Number | 1639184484
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Entity Type | Individual
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Provider Name | SHERYL KAY WILDE LPC
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Gender | Female
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5034 MUND RD
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City | SHAWNEE
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State | KS
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Zip | 66218-9147
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Country | US
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Telephone | 913-422-8477
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Fax | 913-322-4562
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Provider Business Mailing Address
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Address Line | 5034 MUND RD
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City | SHAWNEE
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State | KS
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Zip | 66218-9147
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Country | US
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Telephone | 913-422-8477
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Fax | 913-322-4562
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 928
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License Number State | KS
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