| Doctor Name: | MIRIAM WONNIE |
| NPI Number: | 1235536244 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M ED.,BSL |
| License Number: | BH001706 |
| Business Practice Address: | One West Main Street Fleetwood, PA - 19522 |
| Business Phone Number: | 6109440445 |
| Business Fax Number: | 6109441196 |
| Mailing Address: | 69 Montello Rd, SINKING SPRING |
| State: | PA |
| Postal Code: | 196081515 |
| Phone Number: | 6109274249 |
| Fax Number: | |
| NPI Enumeration Date: | 11/20/2014 |
| NPI Last Update Date: | 11/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | BH001706 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |