Individual
MS. TRACEY JANE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC
Contact information
Practice address
702 E KING RD, TOMAHAWK, WI 54487
(715) 282-7566
Mailing address
6608 FALLEN WOOD LN, RHINELANDER, WI 54501-8191
(715) 282-7566
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
503-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
426259000
—
WI
Enumeration date
04/03/2008
Last updated
04/03/2008
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