Dr. Ivan Robert Wilderman , PhD
Psychologist - Forensic • Holbrook, AZ
Notice of NPI Deactivation & Inactive Practice Status
According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Ivan Wilderman has officially deactivated this NPI record and ceased active healthcare practice.
Professional Overview & Biography Verified Profile Summary
Dr. Ivan Wilderman, PhD was a registered Psychologist - Forensic practicing in Holbrook, AZ. Throughout an active medical career spanning 11 years, Dr. Wilderman provided care at the practice location at 105 N 5TH AVE until profile deactivation on 2017-10-12.
Practice Location & Contact Primary Location
105 N 5th Ave
Holbrook, AZ 860252817
Specialty Benchmarks & Practice Insights
Comparative analytics for Psychologist - Forensic in Holbrook, AZ
Practicing in Holbrook, AZ (21 Statewide)
In-Person Office Visits Only
Under CMS Medicare Fee Schedule vs Standard Submitted Charges
Medical Specialties & State Licenses
NUCC Taxonomy Code: 103TF0200X
A psychologist whose specialty is characterized by activities primarily intended to provide professional psychological expertise within the judicial and legal systems.
Practice Associates & Co-Workers
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Registered Nurse
Registered Nurse
Career & Practice History Timeline
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Record deactivated on October 12, 2017
NPI status registered as active in NPPES database
Registered at 105 N 5TH AVE, HOLBROOK, AZ 860252817 (Tel: 9285246701)
Registered at 105 N 5TH AVE, HOLBROOK, AZ 860252817 (Tel: 9285246701)
Recorded as IVAN WILDERMAN, PHD
Psychologist (License #1901 in AZ)
First registered as active Individual Practitioner in NPPES Database.
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NPI Administrative Meta
Mailing Address
105 N 5th Ave
Holbrook, AZ 860252817
Phone: 9285246701
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