Provider Demographics
NPI:1356980791
Name:VASTINE, WYNDE LYNN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:WYNDE
Middle Name:LYNN
Last Name:VASTINE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:LYNN
Other - Last Name:VASTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:2648 INTERNATIONAL BLVD STE 115 #267
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601
Mailing Address - Country:US
Mailing Address - Phone:510-210-3974
Mailing Address - Fax:
Practice Address - Street 1:450 SUTTER ST STE 1139
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-839-8669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61337301235Z00000X
CASP29299235Z00000X
CA29299235Z00000X
PASL015631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist