Provider Demographics
NPI:1710712963
Name:WILDT, HANNA RAE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:RAE
Last Name:WILDT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:HANNA
Other - Middle Name:RAE
Other - Last Name:DOCKTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1031 IMPERIAL CIR APT 3
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6967
Mailing Address - Country:US
Mailing Address - Phone:763-242-4021
Mailing Address - Fax:
Practice Address - Street 1:504 E 5TH ST
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-2024
Practice Address - Country:US
Practice Address - Phone:715-743-3323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6739154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist