Wilde, Graham Leonard

Wilde, Graham Leonard is an sole proprietor health care provider with primary practice located at 5315B Sunset Blvd , Lexington SC 29072-9159. He recently has only one registered license in Speech, Language and Hearing Service Providers / Audiologist, which is considered as his primary health care specialty. Wilde, Graham Leonard can be contacted via phone (803) 808-9611.

Contact Information

Primary practice address
5315B Sunset Blvd Lexington SC 29072-9159
Phone: (803) 808-9611
Fax: (803) 808-6848
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Audiologist 231H00000X 249 South Carolina
Speech, Language and Hearing Service Providers / Audiologist 231H00000X AUD000296 Georgia

Profile Details

NPI number 1396812376
LBN Legal business name Wilde, Graham Leonard
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 29th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396812376 NPPES
Georgia Other AUD000296 STATE AUDIOLOGY LICENSE
Georgia MEDICAID SA0007 STATE AUDIOLOGY LICENSE
Georgia Other 249 STATE AUDIOLOGY LICENSE

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