| Doctor Name: | MR. SCOTT MICHL WONDERLING |
| NPI Number: | 1902195456 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S. CCC-SLP |
| License Number: | 2202005874 |
| Business Practice Address: | 1800 Cameron Glen Dr Reston, VA - 201903308 |
| Business Phone Number: | 7038345800 |
| Business Fax Number: | |
| Mailing Address: | 12142 Captiva Ct, RESTON |
| State: | VA |
| Postal Code: | 201911221 |
| Phone Number: | 8145919045 |
| Fax Number: | |
| NPI Enumeration Date: | 04/05/2011 |
| NPI Last Update Date: | 04/05/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 2202005874 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |