Provider Demographics
NPI:1922668631
Name:WYMAN, WENDY ANN (HAD)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ANN
Last Name:WYMAN
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:ANN
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13820 DONNYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2827
Mailing Address - Country:US
Mailing Address - Phone:310-989-3092
Mailing Address - Fax:
Practice Address - Street 1:1820 MARRON RD STE 102
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1177
Practice Address - Country:US
Practice Address - Phone:760-434-0125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8365237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist