Provider Demographics
NPI:1992566582
Name:TUTTLE, WANDA (BA)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91310-0092
Mailing Address - Country:US
Mailing Address - Phone:661-425-4704
Mailing Address - Fax:
Practice Address - Street 1:28025 WOODSTOCK AVE
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384-3546
Practice Address - Country:US
Practice Address - Phone:661-803-6783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65322355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant