Provider Demographics
NPI:1437889425
Name:WUTKE, JONATHON M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:M
Last Name:WUTKE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 TURK ST APT 901
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-4789
Mailing Address - Country:US
Mailing Address - Phone:262-206-8127
Mailing Address - Fax:
Practice Address - Street 1:833 MARKET ST STE 809
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1828
Practice Address - Country:US
Practice Address - Phone:415-627-9095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS2452103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist