Doctor Name: | DOROTHY M T WISE |
NPI Number: | 1245442813 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CCC-SLP |
License Number: | 2202003692 |
Business Practice Address: | 5835-a Harbourview Blvd Suffolk, VA - 23435 |
Business Phone Number: | 7576686034 |
Business Fax Number: | |
Mailing Address: | 5916 Hazelcroft Drive, SUFFOLK |
State: | VA |
Postal Code: | 23435 |
Phone Number: | 7576686034 |
Fax Number: | |
NPI Enumeration Date: | 05/04/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2202003692 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |