Provider Demographics
NPI:1619766060
Name:WANKO, EMILIE
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:
Last Name:WANKO
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 PINEWIND DR
Mailing Address - Street 2:
Mailing Address - City:ALBURTIS
Mailing Address - State:PA
Mailing Address - Zip Code:18011-2703
Mailing Address - Country:US
Mailing Address - Phone:570-299-0540
Mailing Address - Fax:
Practice Address - Street 1:1605 PINEWIND DR
Practice Address - Street 2:
Practice Address - City:ALBURTIS
Practice Address - State:PA
Practice Address - Zip Code:18011-2703
Practice Address - Country:US
Practice Address - Phone:570-299-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool