Individual
DR. JACQUELINE W WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
189 W SCHROCK RD, WESTERVILLE, OH 43081-2890
(614) 355-7500
(614) 355-7533
Mailing address
700 CHILDRENS DR, COLUMBUS, OH 43205-2639
(614) 722-2000
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
P.5677
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0121355
—
OH
Enumeration date
07/24/2006
Last updated
04/23/2025
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