Provider Demographics
NPI:1346467248
Name:WISE, KAHTLEEN BETH (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KAHTLEEN
Middle Name:BETH
Last Name:WISE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8702 SW 122ND ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-5740
Mailing Address - Country:US
Mailing Address - Phone:352-495-6261
Mailing Address - Fax:
Practice Address - Street 1:8702 SW 122ND ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-5740
Practice Address - Country:US
Practice Address - Phone:352-495-6261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor