Provider Demographics
NPI:1548237159
Name:WISE, JAMES A (PHD CCC A)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:WISE
Suffix:
Gender:M
Credentials:PHD CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 MISSION RD STE 146
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3005
Mailing Address - Country:US
Mailing Address - Phone:913-384-2105
Mailing Address - Fax:913-384-0735
Practice Address - Street 1:9119 W 74TH ST STE 306
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2229
Practice Address - Country:US
Practice Address - Phone:913-403-0018
Practice Address - Fax:913-432-3619
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS285231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100227760AMedicaid
R89345OtherCOVENTRY
481106646OtherHUMANA
4254145OtherAETNA
KSCE614OtherHEARING AID DISPENSING
KSCE614OtherHEARING AID DISPENSING LI
640002259OtherTRAVELERS MEDICARE
D226472Medicare ID - Type Unspecified
R89345Medicare UPIN