Provider Demographics
NPI:1750631339
Name:WISE, YAEL (SPED)
Entity Type:Individual
Prefix:MRS
First Name:YAEL
Middle Name:
Last Name:WISE
Suffix:
Gender:F
Credentials:SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 COLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-2211
Mailing Address - Country:US
Mailing Address - Phone:585-467-4567
Mailing Address - Fax:
Practice Address - Street 1:41 COLEBROOK DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-2211
Practice Address - Country:US
Practice Address - Phone:585-467-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2323655252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency