Individual
RICHELLE WISDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
119 N BENTON ST, WAYNESVILLE, MO 65583-2501
(573) 433-2833
Mailing address
900 E ROLLA RD, SALEM, MO 65560-2658
(573) 259-7392
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
01/04/2016
Last updated
01/13/2016
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