Basic Information
| Provider Information | |||||||||
| NPI: | 1982636692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WING | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | ED.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8000 FIVE MILE RD. SUITE 240 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132323070 | ||||||||
| FaxNumber: | 5132325794 | ||||||||
| Practice Location | |||||||||
| Address1: | 8000 FIVE MILE RD. SUITE 240 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132323070 | ||||||||
| FaxNumber: | 5132325794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 11/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 4447 | OH | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 040329000 | 01 | OH | MAGELLAN | OTHER | 284429226002 | 01 | OH | MEDICAL MUTUAL | OTHER | 000000011247 | 01 | OH | ANTHEM | OTHER |