Provider Demographics
NPI:1538460290
Name:WOHLWEND, TAMARA ELEANOR (EDS, BCBA, NCSP)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:ELEANOR
Last Name:WOHLWEND
Suffix:
Gender:F
Credentials:EDS, BCBA, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12205 WILDBROOK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-4111
Mailing Address - Country:US
Mailing Address - Phone:813-995-4012
Mailing Address - Fax:
Practice Address - Street 1:12205 WILDBROOK DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-4111
Practice Address - Country:US
Practice Address - Phone:813-995-4012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-07-2222103K00000X
FLSS911103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst