Individual
DR. STEPHEN PONGONIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1400 BELLINGER ST, EAU CLAIRE, WI 54703-5222
(715) 838-5222
Mailing address
PO BOX 1510, EAU CLAIRE, WI 54702-1510
(715) 838-5222
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
20042019A
IN
103T00000X
Psychologist
2781
WI
103TC0700X
Clinical Psychologist
20042019A
IN
103TC0700X
Clinical Psychologist
Primary
2781
WI
103TC2200X
Clinical Child & Adolescent Psychologist
20042019A
IN
103TF0200X
Forensic Psychologist
20042019A
IN
Other
Enumeration date
07/27/2006
Last updated
09/15/2020
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