Individual
DR. ROGER P. WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
306 S INDEPENDENCE ST, HARRISONVILLE, MO 64701-2352
(816) 380-4010
(816) 887-5703
Mailing address
306 S INDEPENDENCE ST, HARRISONVILLE, MO 64701-2352
(816) 380-4010
(816) 887-5703
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
00914
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07108031
BLUE CROSS BLUE SHIELD
MO
05
—
493233209
—
MO
Enumeration date
10/13/2006
Last updated
04/17/2008
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