Individual
JUSTIN M WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
401 E 19TH ST APT 1405, KANSAS CITY, MO 64108-1791
(314) 255-9594
Mailing address
401 E 19TH ST APT 1405, KANSAS CITY, MO 64108-1791
(314) 255-9594
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2018037238
MO
Other
Enumeration date
11/20/2019
Last updated
03/24/2021
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