Provider Demographics
NPI:1316627680
Name:WILDER, KATHERINE LINGLE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LINGLE
Last Name:WILDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 S HOLLY CIR STE 295
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1076
Mailing Address - Country:US
Mailing Address - Phone:720-542-8737
Mailing Address - Fax:
Practice Address - Street 1:12760 STROH RANCH WAY STE 205
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7507
Practice Address - Country:US
Practice Address - Phone:720-542-8737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist