Organization
KELLY WILDER-WILLIS, PHD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY ELIZABETH WILDER-WILLIS PHD (OWNER)
(732) 618-4950
Entity
Organization
Contact information
Practice address
51 HARRISON AVE, RED BANK, NJ 07701-2333
(732) 618-4950
Mailing address
PO BOX 8264, RED BANK, NJ 07701-8264
(732) 618-4950
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
35SI00446400
NJ
Other
Enumeration date
11/15/2007
Last updated
11/15/2007
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