Provider Demographics
NPI:1881655181
Name:WISE, KAY L (AUD)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:L
Last Name:WISE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:WISE
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2440 M STREET NW
Mailing Address - Street 2:SUITE #620
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1565
Mailing Address - Country:US
Mailing Address - Phone:202-785-8300
Mailing Address - Fax:202-785-5040
Practice Address - Street 1:2440 M STREET NW
Practice Address - Street 2:SUITE #620
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1565
Practice Address - Country:US
Practice Address - Phone:202-785-8300
Practice Address - Fax:202-785-5040
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00723231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000A95H24Medicare ID - Type Unspecified
142355ZCFBMedicare PIN