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General NPI Number Information
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NPI Number | 1891411203
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Entity Type | Individual
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Provider Name | KIMBERLY J WISE PH.D., M.AUD., CCC-A
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Gender | Female
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 3601 N DIVISION ST
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City | DAVENPORT
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State | IA
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Zip | 52806-5450
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Country | US
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Telephone | 563-326-5441
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Fax | 888-336-4118
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Provider Business Mailing Address
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Address Line | 3601 N DIVISION ST
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City | DAVENPORT
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State | IA
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Zip | 52806-5450
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Country | US
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Telephone | 563-326-5441
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Fax | 888-336-4118
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 115898
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License Number State | IA
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