Provider Demographics
NPI:1750189684
Name:WYNGLARZ, ALEXA BREANNA (SLP-CCC)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:BREANNA
Last Name:WYNGLARZ
Suffix:
Gender:
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 LOS ALAMOS ST
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2704
Mailing Address - Country:US
Mailing Address - Phone:714-553-5585
Mailing Address - Fax:
Practice Address - Street 1:5810 LOS ALAMOS ST
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-2704
Practice Address - Country:US
Practice Address - Phone:714-553-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist