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NPI Code Detail

MEDICARE: CHERYL WILD

MEDICARE: CHERYL WILD
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1760514053
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERYL WILD
Provider Business Mailing Address
First Line : 8 RUBY DR
Second Line :
City : GROVE CITY
State : PA
Zip : 16127-4686
Country : US
Telephone Number : 724-458-7959
Fax Number :
Provider Business Practice Location Address
First Line : 456 N PITT ST
Second Line :
City : MERCER
State : PA
Zip : 16137-1129
Country : US
Telephone Number : 724-662-7202
Fax Number : 724-662-7208
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2007
Last Update Date : 07/08/2007

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Directions to “ CHERYL WILD ” Practice Location

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