Provider Demographics
NPI:1558512392
Name:WISE, CHERYL H (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:H
Last Name:WISE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 LAWRENCE ST
Mailing Address - Street 2:WESLEY HEALTH CARE CENTER, INC OUTPATIENTS
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-1346
Mailing Address - Country:US
Mailing Address - Phone:518-691-1454
Mailing Address - Fax:
Practice Address - Street 1:131 LAWRENCE ST
Practice Address - Street 2:OUTPATIENTS
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1346
Practice Address - Country:US
Practice Address - Phone:518-691-1454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist