Provider Demographics
NPI:1720286818
Name:WONG, LYNETTE (MS)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 52ND ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1809
Mailing Address - Country:US
Mailing Address - Phone:510-428-8403
Mailing Address - Fax:510-238-9764
Practice Address - Street 1:312 CLAY ST STE 150
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3510
Practice Address - Country:US
Practice Address - Phone:510-428-8403
Practice Address - Fax:510-238-9764
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASLP5700101Y00000X
225400000X
CASP5700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner