Healthcare Provider Details

I. General information

NPI: 1790276335
Provider Name (Legal Business Name): SCOTT WISER SLP-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ABBOTT RD
ANCHORAGE AK
99507-4460
US

IV. Provider business mailing address

1327 KALAKAKET ST
FAIRBANKS AK
99709-4917
US

V. Phone/Fax

Practice location:
  • Phone: 907-301-4588
  • Fax:
Mailing address:
  • Phone: 907-452-4517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number132340
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: