Provider Demographics
NPI:1144521352
Name:WISE, CELESTE P (MED/CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:P
Last Name:WISE
Suffix:
Gender:F
Credentials:MED/CCC-SLP
Other - Prefix:MS
Other - First Name:CELESTE
Other - Middle Name:P
Other - Last Name:PELLETIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED/CCC-SLP
Mailing Address - Street 1:4635 UNION ROAD
Mailing Address - Street 2:ASPIRE CENTER FOR LEARNING
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225
Mailing Address - Country:US
Mailing Address - Phone:716-505-5700
Mailing Address - Fax:
Practice Address - Street 1:4635 UNION ROAD
Practice Address - Street 2:ASPIRE CENTER FOR LEARNING
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225
Practice Address - Country:US
Practice Address - Phone:716-505-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019747-1235Z00000X
NY019747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist