Individual
MRS. ADRIENNE KATHERINE WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC SLP
Contact information
Practice address
1432 SOUTHWEST BLVD, JEFFERSON CITY, MO 65109-2444
(573) 632-5633
(537) 632-5990
Mailing address
5521 DOVE LAKE RD, JEFFERSON CITY, MO 65101-9328
(573) 291-4646
(573) 632-5990
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
117608
MO
Other
Enumeration date
02/12/2007
Last updated
07/08/2007
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