Provider Demographics
NPI:1881890762
Name:WINGATE-GARDNER, STEPHANIE JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JEAN
Last Name:WINGATE-GARDNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:JEAN
Other - Last Name:WINGATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2938 BERKLEY RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1805
Mailing Address - Country:US
Mailing Address - Phone:610-896-0774
Mailing Address - Fax:
Practice Address - Street 1:60 TOWNSHIP LINE RD
Practice Address - Street 2:MOSSREHAB EINSTEIN AT ELKINS PARK
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2220
Practice Address - Country:US
Practice Address - Phone:215-663-6649
Practice Address - Fax:215-663-6989
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009291L103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical