Healthcare Provider Details

I. General information

NPI: 1598682130
Provider Name (Legal Business Name): CINDIE WISENER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 E MARY LN
GILBERT AZ
85295-1736
US

IV. Provider business mailing address

1251 E MARY LN
GILBERT AZ
85295-1736
US

V. Phone/Fax

Practice location:
  • Phone: 480-818-5638
  • Fax:
Mailing address:
  • Phone: 480-818-5638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17580
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: