Individual
TINA WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, BCBA, LBA
Contact information
Practice address
1 OFFICE PKWY, EAST PROVIDENCE, RI 02914-1643
(401) 270-7110
Mailing address
22 10TH ST APT 2, PROVIDENCE, RI 02906-2918
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-22-63182
—
103K00000X
Behavior Analyst
Primary
LBA00435
RI
Other
Enumeration date
06/27/2019
Last updated
06/22/2026
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