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General NPI Number Information
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NPI Number | 1235536244
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Entity Type | Individual
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Provider Name | MIRIAM WONNIE M ED.,BSL
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Gender | Female
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | ONE WEST MAIN STREET
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City | FLEETWOOD
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State | PA
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Zip | 19522
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Country | US
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Telephone | 610-944-0445
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Fax | 610-944-1196
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Provider Business Mailing Address
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Address Line | 69 MONTELLO RD
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City | SINKING SPRING
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State | PA
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Zip | 19608-1515
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Country | US
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Telephone | 610-927-4249
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Fax |
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | BH001706
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | BH001706
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License Number State | PA
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