Provider Demographics
NPI:1205712965
Name:WONDER HAVEN PLLC
Entity type:Organization
Organization Name:WONDER HAVEN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:VANESA
Authorized Official - Last Name:PENKO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:240-938-3719
Mailing Address - Street 1:1014 WILLOW CIR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-6854
Mailing Address - Country:US
Mailing Address - Phone:240-938-3719
Mailing Address - Fax:
Practice Address - Street 1:1014 WILLOW CIR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6854
Practice Address - Country:US
Practice Address - Phone:240-938-3719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health