MEDICARE: MRS. MONICA F. WISER M.A., CCC-A

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
1	231H00000X	Audiologist	3407	SC

General Provider Information

NPI Number	:	1841442571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MONICA F. WISER M.A., CCC-A

Provider Business Mailing Address
First Line	:	PO BOX 1102
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29901-1102
Country	:	US
Telephone Number	:	843-521-3007
Fax Number	:	888-521-3007

Provider Business Practice Location Address
First Line	:	38 PROFESSIONAL VILLAGE CIR
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29907-1570
Country	:	US
Telephone Number	:	843-521-3007
Fax Number	:	888-521-3007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2008
Last Update Date	:	07/08/2010

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