Provider Demographics
NPI:1831397561
Name:WYNNE, ANNE KATHLEEN MCMAHON (BA, MSW)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:KATHLEEN MCMAHON
Last Name:WYNNE
Suffix:
Gender:F
Credentials:BA, MSW
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:KATHLEEN
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2248 DEL MAR RD
Mailing Address - Street 2:#6
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1559
Mailing Address - Country:US
Mailing Address - Phone:818-822-0600
Mailing Address - Fax:
Practice Address - Street 1:2309 DALY ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2230
Practice Address - Country:US
Practice Address - Phone:323-222-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor