Individual
KIRSTEN J WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
1039 STONERIDGE DR STE 5, BOZEMAN, MT 59718-7056
(406) 624-6599
(888) 336-0944
Mailing address
884 QUAIL RUN RD UNIT C, BOZEMAN, MT 59718-8277
(307) 899-3479
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-SP-LIC-5850
MT
Other
Enumeration date
06/13/2016
Last updated
08/27/2020
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