MEDICARE: DR. TONI LEE WYRICK ED.S., PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	6668	FL
2	103G00000X	Clinical Neuropsychologist	3479	NC
3	103TC2200X	Clinical Child & Adolescent Psychologist	3479	NC
4	103T00000X	Psychologist	3479	NC
5	103T00000X	Psychologist	6668	FL
6	103G00000X	Clinical Neuropsychologist	6668	FL

General Provider Information

NPI Number	:	1700053063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONI LEE WYRICK ED.S., PSY.D.

Provider Business Mailing Address
First Line	:	8225 MERRYVALE LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-2659
Country	:	US
Telephone Number	:	828-222-6048
Fax Number	:	828-484-1976

Provider Business Practice Location Address
First Line	:	8225 MERRYVALE LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-2659
Country	:	US
Telephone Number	:	828-222-6048
Fax Number	:	828-484-1976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2026

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