Provider Demographics
NPI:1750102661
Name:WISDOM, EMILY PAIGE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:PAIGE
Last Name:WISDOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 114TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-6302
Mailing Address - Country:US
Mailing Address - Phone:806-744-8999
Mailing Address - Fax:
Practice Address - Street 1:5208 11TH ST APT 226
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4442
Practice Address - Country:US
Practice Address - Phone:903-413-8408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant