Individual
JULIE WISECUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 BRYANT WILLIAMS DR, KLAMATH FALLS, OR 97601-7151
(541) 882-6691
Mailing address
1401 BRYANT WILLIAMS DR, KLAMATH FALLS, OR 97601-7151
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
015294
OR
Other
Enumeration date
06/20/2014
Last updated
06/20/2014
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