Healthcare Provider Details

I. General information

NPI: 1548237159
Provider Name (Legal Business Name): JAMES A WISE PHD CCC A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9119 W 74TH ST STE 306
SHAWNEE MISSION KS
66204-2229
US

IV. Provider business mailing address

7301 MISSION RD STE 146
PRAIRIE VILLAGE KS
66208-3005
US

V. Phone/Fax

Practice location:
  • Phone: 913-403-0018
  • Fax: 913-432-3619
Mailing address:
  • Phone: 913-384-2105
  • Fax: 913-384-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number285
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: