Individual
ELIZABETH WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1122 S 216TH ST, DES MOINES, WA 98198-8301
(206) 878-8915
Mailing address
213 N WALNUT ST, ELMHURST, IL 60126-2635
(630) 441-0637
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.014324
IL
235Z00000X
Speech-Language Pathologist
LL60875357
WA
Other
Enumeration date
01/28/2019
Last updated
01/28/2019
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