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NPI Code Detail

MEDICARE: DR. MARILYN R WANDER PH.D.

MEDICARE: DR. MARILYN R WANDER PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist5564OH
2103TH0100XHealth Service Psychologist5564OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
187726OTHEROHUBH
245020-0001OTHEROHCARE SOURCE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992771679
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARILYN R WANDER PH.D.
Provider Business Mailing Address
First Line : 3253 N BEND RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45239-7610
Country : US
Telephone Number : 513-662-9900
Fax Number : 513-662-9902
Provider Business Practice Location Address
First Line : 3253 N BEND RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45239-7610
Country : US
Telephone Number : 513-622-9900
Fax Number : 513-622-9902
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2006
Last Update Date : 08/23/2010

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