Provider Demographics
NPI:1942407630
Name:WACKER, SVENJA MIRJAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:SVENJA
Middle Name:MIRJAM
Last Name:WACKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 EAST AVE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5014
Mailing Address - Country:US
Mailing Address - Phone:203-855-9691
Mailing Address - Fax:203-855-7743
Practice Address - Street 1:111 EAST AVE
Practice Address - Street 2:SUITE 313
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5014
Practice Address - Country:US
Practice Address - Phone:203-855-9691
Practice Address - Fax:203-855-7743
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002844103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist