Individual
DR. WING MAN FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1 BARNES JEWISH HOSPITAL PLZ, DIV NEUROLOGY NEUROPSYCHOLOGY, SAINT LOUIS, MO 63110-1003
(314) 362-1408
(314) 454-7759
Mailing address
660 S EUCLID AVE, CB 8111, SAINT LOUIS, MO 63110-1010
(314) 362-1408
(314) 454-7759
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
2017002012
MO
103TC0700X
Clinical Psychologist
Primary
071-010809
IL
103TC1900X
Counseling Psychologist
2017002012
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490087956
—
MO
Enumeration date
09/24/2010
Last updated
08/23/2023
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