Individual
CAROLYNN WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S CCC-SLP
Contact information
Practice address
1451 SW 18TH AVE, FORT LAUDERDALE, FL 33312-4163
(570) 239-0396
Mailing address
1451 SW 18TH AVE, FORT LAUDERDALE, FL 33312-4163
(570) 239-0396
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA11607
FL
235Z00000X
Speech-Language Pathologist
SL009241
PA
Other
Enumeration date
07/11/2011
Last updated
10/23/2019
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