Individual
BAMBI LYNN WADELTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PLHD
Contact information
Practice address
13000 SAWGRASS VILLAGE CIR, SUITE 46, PONTE VEDRA BEACH, FL 32082-5016
(904) 280-8555
(904) 280-8562
Mailing address
13000 SAWGRASS VILLAGE CIR, SUITE 46, PONTE VEDRA BEACH, FL 32082-5016
(904) 280-8555
(904) 280-8562
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY5636
FL
Other
Enumeration date
01/11/2007
Last updated
07/08/2007
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