Kelly Wilder-Willis, PHD LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

35SI00446400 Issued in NJ

Legal business name

KELLY WILDER-WILLIS, PHD LLC

Practice address

51 Harrison Ave
Red Bank, NJ 07701-2333

Phone

(732) 618-4950

NPI assigned

Nov 15, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kelly Elizabeth Wilder-Willis, PHD

Title

Owner

Phone

(732) 618-4950

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195084800000",
    "number": "1508047754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8264",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077018264",
            "telephone_number": "732-618-4950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 HARRISON AVE",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077012333",
            "telephone_number": "732-618-4950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY WILDER-WILLIS, PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-15",
        "last_updated": "2007-11-15",
        "status": "A",
        "authorized_official_last_name": "WILDER-WILLIS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-618-4950",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "NJ",
            "license": "35SI00446400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elliot Katz, MSW., LCSW.
• Matthew R. Kaufman, M.D.
• Manpreet Kaur, DDS
• Kathy Rumi Kawaguchi, M.D.
• Ashley Kearns, PA
• Irene A Kelly, APN
• Jamie Marie Kelly, BCBA
• Lorien Kelly, D.O.
• Thomas M Kelly, D.C.
• Lorraine Kennedy, LCSW

• Clinical Neuropsychologist in Red Bank, NJ
• Providers in Red Bank, NJ by specialty
• Clinical Neuropsychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.