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General NPI Number Information
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NPI Number | 1336400498
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Entity Type | Individual
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Provider Name | KRISTEN M. WROCKLAGE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 609 W JOHNSON AVE STE 104
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City | CHESHIRE
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State | CT
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Zip | 06410-4506
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Country | US
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Telephone | 203-272-6007
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Fax | 203-272-8895
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Provider Business Mailing Address
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Address Line | 609 W JOHNSON AVE STE 104
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City | CHESHIRE
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State | CT
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Zip | 06410-4506
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Country | US
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Telephone | 203-272-6007
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Fax | 203-272-8895
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 003174
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License Number State | CT
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