Provider Demographics
NPI:1336365329
Name:WISE-SIEGEL, BARBARA LYNNE (BARBARA WISE-SIEGEL)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:LYNNE
Last Name:WISE-SIEGEL
Suffix:
Gender:F
Credentials:BARBARA WISE-SIEGEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WOODBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5114
Mailing Address - Country:US
Mailing Address - Phone:864-281-0059
Mailing Address - Fax:864-281-0059
Practice Address - Street 1:355 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-2537
Practice Address - Country:US
Practice Address - Phone:864-595-4225
Practice Address - Fax:864-595-4821
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist