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Individual

DR. JONATHAN DAVID WALL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PSY.D.

Contact information

Practice address
27 CENTER ST, CLINTON, NJ 08809-1340
(908) 295-1890
(908) 735-6871
Mailing address
27 CENTER ST, CLINTON, NJ 08809-1340
(908) 295-1890
(908) 735-6871

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
35S100364200
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0070815
NJ
Enumeration date
07/21/2006
Last updated
07/08/2007
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