Active NPI
Tyla Wilder
- Clinical Psychologist
- Green Bay, WI
National Provider Identifier
1598398992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSYC0001630503
- Practice address
- 1575 Allouez Ave
Green Bay, WI 54311-5625 - Phone
- (303) 617-2300
- NPI assigned
- Feb 14, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSYC0001630503 | CO | Primary |
Addresses
Primary practice location
1575 Allouez Ave
Green Bay, WI 54311-5625
Mailing address
1831 S Dunkirk St
Aurora, CO 80017-3282
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSYC0001630503 | CO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1581638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1775433600000",
"number": "1598398992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1831 S DUNKIRK ST",
"city": "AURORA",
"state": "CO",
"postal_code": "800173282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1575 ALLOUEZ AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543115625",
"telephone_number": "303-617-2300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDER",
"first_name": "TYLA",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-14",
"last_updated": "2026-04-06",
"certification_date": "2026-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "PSYC0001630503",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.