Individual
HEATHER S WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1350 E WOODROW WILSON AVE, JACKSON, MS 39216-5112
(601) 981-2611
Mailing address
1350 E WOODROW WILSON AVE, JACKSON, MS 39216-5112
(601) 981-2611
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S2977
MS
Other
Enumeration date
04/25/2008
Last updated
04/25/2008
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