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General NPI Number Information
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NPI Number | 1326485707
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Entity Type | Individual
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Provider Name | LEIGHANN S WONG PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/26/2013
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 8359 BEACON BLVD STE 503
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City | FORT MYERS
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State | FL
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Zip | 33907
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Country | US
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Telephone | 239-599-5656
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Fax | 239-599-5655
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Provider Business Mailing Address
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Address Line | 8359 BEACON BLVD STE 503
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City | FORT MYERS
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State | FL
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Zip | 33907-3066
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Country | US
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Telephone | 239-599-5656
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Fax | 239-599-5655
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 8727
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License Number State | FL
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