Individual
DEBORAH LYNN WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
3100 W RAY RD, CHANDLER, AZ 85226-2470
(480) 207-5975
Mailing address
10222 S 48TH PL, PHOENIX, AZ 85044-1228
(480) 235-2277
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0046
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0046
AZ. SPEECH PATHOLOGY LICENSE
AZ
01
—
00500223
ASHA CERTIFICATION #
—
05
—
824137
—
AZ
Enumeration date
12/06/2006
Last updated
10/28/2016
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