Provider Demographics
NPI:1356088447
Name:WISEMAN SLP SERVICES PLLC
Entity type:Organization
Organization Name:WISEMAN SLP SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:828-748-5558
Mailing Address - Street 1:1436 JACK MCKINNEY RD
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-7743
Mailing Address - Country:US
Mailing Address - Phone:828-748-5558
Mailing Address - Fax:
Practice Address - Street 1:1436 JACK MCKINNEY RD
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-7743
Practice Address - Country:US
Practice Address - Phone:828-748-5558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech