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NPI Code Detail

MEDICARE: CHRISTA WISE

MEDICARE: CHRISTA WISE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist22003465AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
122003465AOTHERINSPEECH PATHOLOGIS LICENSE

General Provider Information

NPI Number : 1275788861
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTA WISE
Provider Business Mailing Address
First Line : 114 E STREETER AVE
Second Line :
City : MUNCIE
State : IN
Zip : 47303-1909
Country : US
Telephone Number : 765-284-4166
Fax Number : 765-287-9547
Provider Business Practice Location Address
First Line : 114 E STREETER AVE
Second Line :
City : MUNCIE
State : IN
Zip : 47303-1909
Country : US
Telephone Number : 765-284-4166
Fax Number : 765-287-9547
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2008
Last Update Date : 11/24/2008

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Directions to “ CHRISTA WISE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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