Provider Demographics
NPI:1982636692
Name:WING, WILLIAM M (EDD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:WING
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 FIVE MILE RD. SUITE 240
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230
Mailing Address - Country:US
Mailing Address - Phone:513-232-3070
Mailing Address - Fax:513-232-5794
Practice Address - Street 1:8000 FIVE MILE RD. SUITE 240
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230
Practice Address - Country:US
Practice Address - Phone:513-232-3070
Practice Address - Fax:513-232-5794
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4447103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH040329000OtherMAGELLAN
OH284429226002OtherMEDICAL MUTUAL
OH000000011247OtherANTHEM
OH000000011247OtherANTHEM
OH040329000OtherMAGELLAN