Individual
MRS. LISA JEAN WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC SLP
Contact information
Practice address
2200 W HIGHWAY 54, VAN-FAR R-1 SCHOOL DISTRICT, VANDALIA, MO 63382-1130
(573) 594-6111
(573) 594-2878
Mailing address
4398 HIGHWAY W, VANDALIA, MO 63382-4408
(573) 721-5568
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2002013175
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
467477907
—
MO
Enumeration date
02/22/2007
Last updated
09/21/2007
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