Provider Demographics
NPI:1164859641
Name:WISE, JACLYNN COSAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JACLYNN
Middle Name:COSAN
Last Name:WISE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N CRAIG ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-684-7009
Mailing Address - Fax:878-999-2920
Practice Address - Street 1:201 N CRAIG ST
Practice Address - Street 2:SUITE 503
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-684-7009
Practice Address - Fax:878-999-2920
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health