Provider Demographics
NPI:1952631905
Name:WISE-MCPHERSON, DIANA K (AUD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:K
Last Name:WISE-MCPHERSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 BELL ST UNIT 116
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-4100
Mailing Address - Country:US
Mailing Address - Phone:806-418-2710
Mailing Address - Fax:
Practice Address - Street 1:3440 BELL ST UNIT 116
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-4100
Practice Address - Country:US
Practice Address - Phone:806-418-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51061237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter