Provider Demographics
NPI:1962219022
Name:WONDRACK, REBECCA (SCHOOL PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WONDRACK
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 RANDOLPH WAY APT 304
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4914
Mailing Address - Country:US
Mailing Address - Phone:410-299-0044
Mailing Address - Fax:
Practice Address - Street 1:8160 RANDOLPH WAY APT 304
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4914
Practice Address - Country:US
Practice Address - Phone:410-299-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool