Provider Demographics
NPI:1912698374
Name:WISDOM, ALLISON JANE
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:JANE
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 1:3458 HIGHWAY 221 N
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-4748
Mailing Address - Country:US
Mailing Address - Phone:870-350-4850
Mailing Address - Fax:
Practice Address - Street 1:1004 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-4330
Practice Address - Country:US
Practice Address - Phone:870-654-3869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2021922355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant