Individual
KELLY WILDER-WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
51 HARRISON AVE, RED BANK, NJ 07701-2333
(732) 618-4950
(732) 219-1910
Mailing address
51 HARRISON AVE, RED BANK, NJ 07701-2333
(732) 618-4950
(732) 219-1910
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PS00857
RI
Other
Enumeration date
07/17/2006
Last updated
07/09/2012
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