Provider Demographics
NPI:1215131461
Name:WISELEY, SANDRA MARIE (MA)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARIE
Last Name:WISELEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:MARIE
Other - Last Name:KREIDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2192 STRINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2929
Mailing Address - Country:US
Mailing Address - Phone:614-875-5100
Mailing Address - Fax:614-875-8529
Practice Address - Street 1:2192 STRINGTOWN RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2929
Practice Address - Country:US
Practice Address - Phone:614-875-5100
Practice Address - Fax:614-875-8529
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01404231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWI4215221Medicare PIN