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General NPI Number Information
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NPI Number | 1134464191
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Entity Type | Individual
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Provider Name | KATHERINE M WYNNE
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Gender | Female
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 12/03/2012
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Provider Practice Location Address
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Address Line | 1096 OWLS CREEK LN
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-5842
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Country | US
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Telephone | 757-971-2240
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Fax |
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Provider Business Mailing Address
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Address Line | 1096 OWLS CREEK LN
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-5842
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-12-10025
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License Number State | VA
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