Anna Wise, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

112574 Issued in TX

Practice address

5012 Wenonah Dr
Dallas, TX 75209-4833

Phone

(662) 574-3861

NPI assigned

Apr 3, 2018

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 names 1

• Anna McKissack Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522713600000",
    "number": "1992201412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5012 WENONAH DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752094833",
            "telephone_number": "662-574-3861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5012 WENONAH DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752094833",
            "telephone_number": "662-574-3861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "ANNA",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-03",
        "last_updated": "2018-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "112574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNA",
            "last_name": "MCKISSACK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Allison Malik Wippert, CNIM
• Anbereen Wiqar, OTR
• Wisconsin Outpatient Services SC
• Wise Nutrition Counseling LLC
• Amanda Tuyet-Anh Wise, D.O.
• Christina Lynne Wise, PH.D.
• Kenneth F. Wise, PSY.D.
• Margaret F Wise, OTR, CHT, CVE
• Matthew W. Wise, DO
• Ciara Lauren Wisecup, MD

• Speech-Language Pathologist in Dallas, TX
• Providers in Dallas, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2018; 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.