| Doctor Name: | KIMBERLY SUE WISE |
| NPI Number: | 1740408608 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CCC-SLP |
| License Number: | S2834 |
| Business Practice Address: | 4692 Spottswood Ave Memphis, TN - 381174822 |
| Business Phone Number: | 9016475682 |
| Business Fax Number: | 9017617171 |
| Mailing Address: | 585 Cedar Grove Cv, HERNANDO |
| State: | MS |
| Postal Code: | 386326656 |
| Phone Number: | 9016475682 |
| Fax Number: | 9017617171 |
| NPI Enumeration Date: | 04/23/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | S2834 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MS |
| 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 |