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General NPI Number Information
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NPI Number | 1205056298
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Entity Type | Individual
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Provider Name | MARY JANE SONNTAG PSYD PSYCHOLOGIST
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2015
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Provider Practice Location Address
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Address Line | 1116 S WALTON BLVD
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City | BENTONVILLE
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State | AR
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Zip | 72712-6122
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Country | US
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Telephone | 479-270-3302
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Fax | 479-845-3946
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Provider Business Mailing Address
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Address Line | 1116 S WALTON BLVD
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City | BENTONVILLE
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State | AR
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Zip | 72712-6122
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Country | US
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Telephone | 479-270-3302
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Fax | 479-845-3946
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 892P
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License Number State | AR
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