Provider Demographics
NPI:1023358447
Name:WISEMAN, MELANIE LYNN (MS SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:LYNN
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4741 S LIVERPOOL CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-6697
Mailing Address - Country:US
Mailing Address - Phone:303-731-7830
Mailing Address - Fax:
Practice Address - Street 1:2851 S PARKER RD STE 570
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2749
Practice Address - Country:US
Practice Address - Phone:303-888-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO54042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist