Active NPI
Bruce Wisenburn, CCC-SLP
- Speech-Language Pathologist
- Scranton, PA
National Provider Identifier
1154460426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SL009766
- Practice address
- 2300 Adams Ave
Marywood University
Scranton, PA 18509-1514 - Phone
- (570) 348-6299
- Fax
- (570) 961-4708
- NPI assigned
- Feb 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SL009766 | PA | Primary |
Addresses
Primary practice location
2300 Adams Ave
Marywood University
Scranton, PA 18509-1514
Mailing address
1185 Audubon Dr
South Abington Township, PA 18411-2852
Phone (570) 585-9807
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SL009766 | PA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284336000000",
"number": "1154460426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1185 AUDUBON DR",
"city": "SOUTH ABINGTON TOWNSHIP",
"state": "PA",
"postal_code": "184112852",
"telephone_number": "570-585-9807",
"fax_number": "570-961-4708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 ADAMS AVE",
"address_2": "MARYWOOD UNIVERSITY",
"city": "SCRANTON",
"state": "PA",
"postal_code": "185091514",
"telephone_number": "570-348-6299",
"fax_number": "570-961-4708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISENBURN",
"first_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "CCC-SLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-05",
"last_updated": "2010-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "PA",
"license": "SL009766",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scranton, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.