Provider Demographics
NPI:1376907808
Name:WISE, DOROTHEA ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHEA
Middle Name:ANN
Last Name:WISE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 RIDGECREST RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1345
Mailing Address - Country:US
Mailing Address - Phone:330-836-1116
Mailing Address - Fax:
Practice Address - Street 1:760 RIDGECREST RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1345
Practice Address - Country:US
Practice Address - Phone:330-836-1116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3605750235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist