Individual
MRS. AMANDA YOUNG WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
128 SUNTREE DR, ADVANCE, NC 27006-7274
(336) 575-1770
Mailing address
128 SUNTREE DR, ADVANCE, NC 27006-7274
(336) 575-1770
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
3598
AR
235Z00000X
Speech-Language Pathologist
Primary
5645
NC
Other
Enumeration date
08/17/2016
Last updated
08/17/2016
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