Provider Demographics
NPI:1396433082
Name:WILDER, BARBARA SPECHT (CCC-SLP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:SPECHT
Last Name:WILDER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MALVERN CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3646
Mailing Address - Country:US
Mailing Address - Phone:717-881-4200
Mailing Address - Fax:
Practice Address - Street 1:100 MALVERN CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3646
Practice Address - Country:US
Practice Address - Phone:717-881-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist