Healthcare Provider Details

I. General information

NPI: 1003963844
Provider Name (Legal Business Name): MARIANNE KATZ WOHL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 WEST MARKET STREET SUITE NUMBER 11
FAIRLAWN OH
44333-3318
US

IV. Provider business mailing address

3250 WEST MARKET STREET SUITE NUMBER 11
FAIRLAWN OH
44333-3318
US

V. Phone/Fax

Practice location:
  • Phone: 330-873-1151
  • Fax: 330-873-1151
Mailing address:
  • Phone: 330-873-1151
  • Fax: 330-873-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number3112
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: