MEDICARE: DR. NATALIA WANNON PSY.D.

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	103TC0700X	Clinical Psychologist	1912302308	VA

General Provider Information

NPI Number	:	1912302308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATALIA WANNON PSY.D.

Provider Business Mailing Address
First Line	:	1408 N FILLMORE ST STE 2
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-3819
Country	:	US
Telephone Number	:	301-325-5130
Fax Number	:

Provider Business Practice Location Address
First Line	:	1408 N FILLMORE ST STE 2
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-3819
Country	:	US
Telephone Number	:	301-325-5130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2014
Last Update Date	:	04/15/2020

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