Provider Demographics
NPI:1598839631
Name:WISEHART, TASHA (MS CCC)
Entity Type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:
Last Name:WISEHART
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 FAIRBROOK CIR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-3502
Mailing Address - Country:US
Mailing Address - Phone:770-418-1778
Mailing Address - Fax:770-418-1794
Practice Address - Street 1:3483 SATELLITE BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8692
Practice Address - Country:US
Practice Address - Phone:770-418-1778
Practice Address - Fax:770-418-1794
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist