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NPI Code Detail

MEDICARE: PONDER MENTAL WELLNESS, PLLC

MEDICARE: PONDER MENTAL WELLNESS, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1790635027
Entity Type Code : Organization
Provider Name (Legal Business Name) : PONDER MENTAL WELLNESS, PLLC
Provider Business Mailing Address
First Line : 5454 S SHORE DR APT 311
Second Line :
City : CHICAGO
State : IL
Zip : 60615-5967
Country : US
Telephone Number : 872-216-3348
Fax Number :
Provider Business Practice Location Address
First Line : 5454 S SHORE DR APT 311
Second Line :
City : CHICAGO
State : IL
Zip : 60615-5967
Country : US
Telephone Number : 872-216-3348
Fax Number :
Authorized Official
Title or Position : CO-OWNER
Name : KHANH NGOC NGHIEM
Credential : PHD
Telephone Number : 872-216-3348
Provider Enumeration Date : 01/28/2026
Last Update Date : 05/13/2026

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Directions to “PONDER MENTAL WELLNESS, PLLC ” Practice Location

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