Provider Demographics
NPI:1205490109
Name:WYNER, SEAN ALAN (MS, SLP-CF)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:ALAN
Last Name:WYNER
Suffix:
Gender:M
Credentials:MS, SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22538 CLARENDON ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4428
Mailing Address - Country:US
Mailing Address - Phone:818-274-8062
Mailing Address - Fax:
Practice Address - Street 1:5567 RESEDA BLVD STE 107
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2648
Practice Address - Country:US
Practice Address - Phone:818-274-8062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist