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NPI Code Detail

MEDICARE: JESSICA A WILDE AUD

MEDICARE: JESSICA A WILDE AUD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1231H00000XAudiologist147001884IL

General Provider Information

NPI Number : 1093446239
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA A WILDE AUD
Provider Business Mailing Address
First Line : 101 E MILLER RD
Second Line :
City : STERLING
State : IL
Zip : 61081-1252
Country : US
Telephone Number : 815-625-4790
Fax Number :
Provider Business Practice Location Address
First Line : 101 E MILLER RD
Second Line :
City : STERLING
State : IL
Zip : 61081-1252
Country : US
Telephone Number : 815-625-4790
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2022
Last Update Date : 04/06/2026

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Directions to “ JESSICA A WILDE AUD” Practice Location

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