Provider Demographics
NPI:1649551359
Name:WYMAN, LINDA M (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:M
Last Name:WYMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2505
Mailing Address - Country:US
Mailing Address - Phone:510-530-4094
Mailing Address - Fax:
Practice Address - Street 1:150 GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3726
Practice Address - Country:US
Practice Address - Phone:510-451-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 8919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist