Healthcare Provider Details

I. General information

NPI: 1891124368
Provider Name (Legal Business Name): SARAH SEAVERS WISE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W NORTH AVE STE 110
MELROSE PARK IL
60160-1629
US

IV. Provider business mailing address

675 W NORTH AVE STE 110
MELROSE PARK IL
60160-1629
US

V. Phone/Fax

Practice location:
  • Phone: 708-538-5747
  • Fax: 708-538-5559
Mailing address:
  • Phone: 708-538-5747
  • Fax: 708-538-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147001485
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: