Provider Demographics
NPI:1538561790
Name:WENNER, CHRISTOPHER JONAH (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JONAH
Last Name:WENNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 N CAMPBELL AVE # 322
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1527
Mailing Address - Country:US
Mailing Address - Phone:520-279-6686
Mailing Address - Fax:
Practice Address - Street 1:3661 N CAMPBELL AVE # 322
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1527
Practice Address - Country:US
Practice Address - Phone:520-279-6686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4542103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical