Provider Demographics
NPI:1730789942
Name:WYNNE, DION FITZGERALD
Entity type:Individual
Prefix:
First Name:DION
Middle Name:FITZGERALD
Last Name:WYNNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 A ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1824
Mailing Address - Country:US
Mailing Address - Phone:907-306-6601
Mailing Address - Fax:
Practice Address - Street 1:6401 A ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1824
Practice Address - Country:US
Practice Address - Phone:907-306-6601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health