Individual
KAYLIE WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1708 W ROGERS AVE, BALTIMORE, MD 21209-4545
(410) 578-8600
Mailing address
632 D ST SE, WASHINGTON, DC 20003-2710
(360) 223-3080
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
06622
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2018
Last updated
02/05/2021
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