Provider Demographics
NPI:1699668855
Name:WIMMER, CHRISTIAN LANCE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:LANCE
Last Name:WIMMER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5057 CARILLON LN
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-3117
Mailing Address - Country:US
Mailing Address - Phone:515-509-5670
Mailing Address - Fax:
Practice Address - Street 1:5057 CARILLON LN
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-3117
Practice Address - Country:US
Practice Address - Phone:515-509-5670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001260103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist