Provider Demographics
NPI:1164043188
Name:WISE, JEFFREY WAYNE (AUD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WAYNE
Last Name:WISE
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2310
Mailing Address - Country:US
Mailing Address - Phone:224-350-2550
Mailing Address - Fax:
Practice Address - Street 1:731 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2310
Practice Address - Country:US
Practice Address - Phone:224-350-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist