Nichole Doreen Wilder, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

LL00004380 Issued in WA

Practice address

2700 Simpson Ave Ste 201
Aberdeen, WA 98520-4333

Phone

(360) 537-2743

Fax

(360) 537-6812

NPI assigned

Jul 10, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Nichole Doreen Robertson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northwest Healthcare Alliance, Inc.

  • Community Based Hospice Care Agency
  • Centralia, WA
  • NPI 1154426815
  NPD (past)

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456358400000",
    "number": "1962666735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 SIMPSON AVE STE 201",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985204333",
            "telephone_number": "360-537-2743",
            "fax_number": "360-537-6812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 SIMPSON AVE STE 201",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985204333",
            "telephone_number": "360-537-2743",
            "fax_number": "360-537-6812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "NICHOLE",
        "middle_name": "DOREEN",
        "name_prefix": "Mrs.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-10",
        "last_updated": "2016-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL00004380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICHOLE",
            "last_name": "ROBERTSON",
            "middle_name": "DOREEN",
            "prefix": "MRS.",
            "credential": "MS CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kelly Westlund, PTA
• Jaison Whipkey
• Brian Whitehall
• George M Whitehead, D.D.S.
• Ann M Whiting
• Cheryl Wilkinson
• Brett J Will, DDS
• William P. Hofmann, MD PLLC
• Chelsea Williams
• Holly Michelle Williams, RN

• Speech-Language Pathologist in Aberdeen, WA
• Providers in Aberdeen, WA by specialty
• Speech-Language Pathologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2016; 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.