Provider Demographics
NPI:1407531718
Name:WISE, SCOTT (HA 61364303)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:WISE
Suffix:
Gender:M
Credentials:HA 61364303
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 W DOLARWAY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-8241
Mailing Address - Country:US
Mailing Address - Phone:509-925-2211
Mailing Address - Fax:
Practice Address - Street 1:2205 W DOLARWAY RD STE 1
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-8241
Practice Address - Country:US
Practice Address - Phone:509-925-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA61364303237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist