Lisa Jean Wise, MA CCC SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2002013175 Issued in MO

Practice address

2200 W Highway 54
Van-Far R-1 School District
Vandalia, MO 63382-1130

Phone

(573) 594-6111

Fax

(573) 594-2878

NPI assigned

Feb 22, 2007

Last updated

Sep 21, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190332800000",
    "number": "1316072903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4398 HIGHWAY W",
            "city": "VANDALIA",
            "state": "MO",
            "postal_code": "633824408",
            "telephone_number": "573-721-5568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 W HIGHWAY 54",
            "address_2": "VAN-FAR R-1 SCHOOL DISTRICT",
            "city": "VANDALIA",
            "state": "MO",
            "postal_code": "633821130",
            "telephone_number": "573-594-6111",
            "fax_number": "573-594-2878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "LISA",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "MA CCC SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-22",
        "last_updated": "2007-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2002013175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "467477907",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tri County Nursing Home District (Tri County Care Center)
• Aaron Trone, M.D.
• Van Far Ambulance District
• Van Far R-I
• Van-Far R1 Schools
• Linda Fay Witte, SLP

• Speech-Language Pathologist in Vandalia, MO
• Providers in Vandalia, MO by specialty
• Speech-Language Pathologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.