Provider Demographics
NPI:1811739022
Name:WISE, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:WISE
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:PO BOX 82
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:IA
Mailing Address - Zip Code:52253-0082
Mailing Address - Country:US
Mailing Address - Phone:319-936-3359
Mailing Address - Fax:
Practice Address - Street 1:4717 SULLIVAN SLOUGH RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-9013
Practice Address - Country:US
Practice Address - Phone:319-752-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0542101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor