Individual
KIMBERLY SUE WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
4692 SPOTTSWOOD AVE, MEMPHIS, TN 38117-4822
(901) 647-5682
(901) 761-7171
Mailing address
585 CEDAR GROVE CV, HERNANDO, MS 38632-6656
(901) 647-5682
(901) 761-7171
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0000001728
TN
235Z00000X
Speech-Language Pathologist
S2834
MS
Other
Enumeration date
04/23/2007
Last updated
07/08/2007
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