Provider Demographics
NPI:1073858486
Name:WYNNE, AUDREY ANN (MHP)
Entity Type:Individual
Prefix:MISS
First Name:AUDREY
Middle Name:ANN
Last Name:WYNNE
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10537 S ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1933
Mailing Address - Country:US
Mailing Address - Phone:708-233-6685
Mailing Address - Fax:708-233-0231
Practice Address - Street 1:10537 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1933
Practice Address - Country:US
Practice Address - Phone:708-233-6685
Practice Address - Fax:708-233-0231
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor