Provider Demographics
NPI:1518939339
Name:WYNNE, PEGGY J (MA)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:J
Last Name:WYNNE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 STONERIDGE MALL RD
Mailing Address - Street 2:SUITE 265
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2822
Mailing Address - Country:US
Mailing Address - Phone:924-225-1942
Mailing Address - Fax:925-225-1791
Practice Address - Street 1:5700 STONERIDGE MALL RD
Practice Address - Street 2:SUITE 265
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2822
Practice Address - Country:US
Practice Address - Phone:924-225-1942
Practice Address - Fax:925-225-1791
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28190106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist