Provider Demographics
NPI:1891411203
Name:WISE, KIMBERLY J (PHD, MAUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:J
Last Name:WISE
Suffix:
Gender:F
Credentials:PHD, MAUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-5450
Mailing Address - Country:US
Mailing Address - Phone:563-326-5441
Mailing Address - Fax:888-336-4118
Practice Address - Street 1:3601 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5450
Practice Address - Country:US
Practice Address - Phone:563-326-5441
Practice Address - Fax:888-336-4118
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA115898237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter