Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PSY32223 | CA |
NPI | 1083218812 |
---|---|
Provider Name | Dr. Stephanie Nicole Wong |
First Address | Palo Alto, CA 94304-1207 |
Second Address | Palo Alto, CA 94304-1207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2020 |
Last Update Date | 23/11/2020 |