Individual
KRISTINA WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
203 W WAYNE ST STE 317, FORT WAYNE, IN 46802
(260) 333-9703
Mailing address
203 W WAYNE ST STE 317, FORT WAYNE, IN 46802-3610
(260) 333-9703
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34008004A
IN
Other
Enumeration date
11/29/2006
Last updated
06/06/2018
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