Provider Demographics
NPI:1205252178
Name:WISE, HEATHER JANET (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JANET
Last Name:WISE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9126 PR 2315
Mailing Address - Street 2:
Mailing Address - City:QUINLAN
Mailing Address - State:TX
Mailing Address - Zip Code:75474-8057
Mailing Address - Country:US
Mailing Address - Phone:903-268-2714
Mailing Address - Fax:
Practice Address - Street 1:810 E OLD GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-4524
Practice Address - Country:US
Practice Address - Phone:972-636-2413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist