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General NPI Number Information
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NPI Number | 1962309617
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Entity Type | Individual
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Provider Name | SHANNON ELIZABETH WILDER
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Gender | Female
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Dates
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Enumeration Date | 10/23/2026
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Last Update Date | 10/23/2026
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Provider Practice Location Address
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Address Line | 489 WASHINGTON ST STE 102
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City | AUBURN
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State | MA
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Zip | 01501-5709
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Country | US
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Telephone | 508-297-9728
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Fax |
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Provider Business Mailing Address
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Address Line | 105 PINE ST
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City | LEICESTER
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State | MA
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Zip | 01524-1637
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Country | US
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Telephone | 508-723-4985
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | MA
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