Sally Wynn, SUDCC IV-CS

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

5940 Issued in CA

Practice address

2100 Capitol Ave
Sacramento, CA 95816-5721

Phone

(916) 317-4464

NPI assigned

Apr 18, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1336406024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3882 STILLMAN PARK CIR SPC 41",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958243666",
            "telephone_number": "916-317-4464",
            "fax_number": "916-970-5091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 CAPITOL AVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958165721",
            "telephone_number": "916-317-4464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "SALLY",
        "name_prefix": "Dr.",
        "credential": "SUDCC IV-CS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-18",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "W0702211501",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "5940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA ASSOCIATION OF DUI TREATMENT PROGRAMS",
            "identifier": "5940",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BREINING - MASTERS LEVEL REGISTERED ADDICTION SPECIALIST",
            "identifier": "W0702211501",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mari Wyley
• Richard Hamilton Wylie
• Houston Edward Wyllie, ASW
• Rebecca Laine Wyma
• Alicia Wynia
• Teresa Luz Wynn, LVN
• Lisamarie Christy Wynne, SLP
• Mellany Wynne, DO
• Wynspring Family Resource Center
• Wynspring Family Resource Center

• Addiction (Substance Use Disorder) Counselor in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.