Provider Demographics
NPI:1427287341
Name:WISEMAN, KRISTA LEE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:LEE
Last Name:WISEMAN
Suffix:
Gender:
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 1:1436 JACK MCKINNEY RD
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-7743
Mailing Address - Country:US
Mailing Address - Phone:828-748-5558
Mailing Address - Fax:
Practice Address - Street 1:1436 JACK MCKINNEY RD
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-7743
Practice Address - Country:US
Practice Address - Phone:828-748-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9036235Z00000X
SC7940235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist