Individual
STEPHEN A WONDERLICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
100 4TH ST S, FARGO, ND 58103-1929
(701) 234-4111
(701) 234-4130
Mailing address
100 4TH ST S, FARGO, ND 58103-1929
(701) 234-4111
(701) 234-4130
Taxonomy
Speciality
Code
Description
License number
State
103TP0814X
Psychoanalysis Psychologist
Primary
187
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014550500
—
MN
05
—
16965
—
ND
Enumeration date
07/22/2006
Last updated
11/10/2008
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