1831368885 NPI number — DR. MICHELLE LOUISE WONDERS PSYD

Table of content: DR. MICHELLE LOUISE WONDERS PSYD (NPI 1831368885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831368885 NPI number — DR. MICHELLE LOUISE WONDERS PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WONDERS
Provider First Name:
MICHELLE
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERRIGEL
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831368885
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 427
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWFOUNDLAND
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18445-0427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-942-9190
Provider Business Mailing Address Fax Number:
570-252-4058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RT. 390
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAINHOME
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-942-9190
Provider Business Practice Location Address Fax Number:
570-252-4058
Provider Enumeration Date:
02/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PS016717 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: PS016717 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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