Healthcare Provider Details

I. General information

NPI: 1376107557
Provider Name (Legal Business Name): WONDERMENT THERAPIES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 PHEASANT RUN AVE
DICKINSON ND
58601-6536
US

IV. Provider business mailing address

PO BOX 3201
DICKINSON ND
58602-3201
US

V. Phone/Fax

Practice location:
  • Phone: 701-710-0800
  • Fax:
Mailing address:
  • Phone: 701-765-3064
  • Fax: 701-765-3064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNA M WEISZ
Title or Position: OWNER
Credential: OTR/L, BCBA, LABA
Phone: 701-765-3064