Provider Demographics
NPI:1861803918
Name:WANNER, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:WANNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N FRONT ST
Mailing Address - Street 2:BDG 1, SUITE 201
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1086
Mailing Address - Country:US
Mailing Address - Phone:717-238-3549
Mailing Address - Fax:717-234-2367
Practice Address - Street 1:2101 N FRONT ST
Practice Address - Street 2:BDG 1, SUITE 201
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1086
Practice Address - Country:US
Practice Address - Phone:717-238-3549
Practice Address - Fax:717-234-2367
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional