| Doctor Name: | MRS. LISA JEAN WISE |
| NPI Number: | 1316072903 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA CCC SLP |
| License Number: | 2002013175 |
| Business Practice Address: | 2200 W Highway 54 Van-far R-1 School District Vandalia, MO - 633821130 |
| Business Phone Number: | 5735946111 |
| Business Fax Number: | 5735942878 |
| Mailing Address: | 4398 Highway W, VANDALIA |
| State: | MO |
| Postal Code: | 633824408 |
| Phone Number: | 5737215568 |
| Fax Number: | |
| NPI Enumeration Date: | 02/22/2007 |
| NPI Last Update Date: | 09/21/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 2002013175 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| 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 |