Healthcare Provider Details

I. General information

NPI: 1295404176
Provider Name (Legal Business Name): DEBORAH M WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W 2ND ST
PERRYSBURG OH
43551-1471
US

IV. Provider business mailing address

2336 CHELTENHAM RD
TOLEDO OH
43606-3232
US

V. Phone/Fax

Practice location:
  • Phone: 419-318-7309
  • Fax:
Mailing address:
  • Phone: 419-699-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2507115
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: