Individual
TANNER FONJWENG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4023 KENNETT PIKE # 988, WILMINGTON, DE 19807-2018
(484) 577-9928
Mailing address
31 WHITE BIRCH BLVD, BEAR, DE 19701-4121
(302) 507-6742
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/10/2021
Last updated
10/10/2021
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