Robert Edward Wilder Jr., M.DIV., M.ED.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MT 0001634 Issued in FL

Practice address

11924 San Jose Blvd
Jacksonville, FL 32223-1840

Phone

(904) 866-1556

Fax

(904) 287-7576

NPI assigned

Aug 12, 2006

Last updated

Jan 11, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200009600000",
    "number": "1710999537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1809 LOCHAMY LN",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322595479",
            "telephone_number": "904-866-1556",
            "fax_number": "904-287-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11924 SAN JOSE BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322231840",
            "telephone_number": "904-866-1556",
            "fax_number": "904-287-7576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "ROBERT",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "M.DIV., M.ED.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2008-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "MT 0001634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa Jaclyn Wilczak, D.C.
• Steven Edward Wildasin, CRNA
• Nicholas Emil Wilde, MD
• Rebekah Leah Wildenberg
• Alyson Gibson Wilder, PHARMD, BCPS
• Carrie Wildes
• Wildflower Pediatric Therapy
• Wildflowers & Weeds
• Wildly Authentic Counseling, LLC
• Wiles & Associates 6970 PA

• Marriage & Family Therapist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Marriage & Family Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2008; 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.