Healthcare Provider Details

I. General information

NPI: 1942117288
Provider Name (Legal Business Name): SHANIECE WISE PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SE DOUGLAS ST STE D
LEES SUMMIT MO
64063-4260
US

IV. Provider business mailing address

11322 MONTGALL AVE APT 1-1305
KANSAS CITY MO
64137-3579
US

V. Phone/Fax

Practice location:
  • Phone: 816-298-9456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: