Provider Demographics
NPI:1598298622
Name:WYCKOFF, LYNETTE ELIZABETH (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:ELIZABETH
Last Name:WYCKOFF
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16782 VON KARMAN AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-2417
Mailing Address - Country:US
Mailing Address - Phone:949-833-2237
Mailing Address - Fax:949-457-9213
Practice Address - Street 1:3641 VISTA VIEW CIR
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765-5655
Practice Address - Country:US
Practice Address - Phone:435-767-7929
Practice Address - Fax:435-710-1007
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-25329103K00000X
UT13431914-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst