Provider Demographics
NPI:1437401833
Name:WISEMAN, KERI (MS, CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24178 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:ALVO
Mailing Address - State:NE
Mailing Address - Zip Code:68304-2150
Mailing Address - Country:US
Mailing Address - Phone:402-781-2349
Mailing Address - Fax:
Practice Address - Street 1:14621 HEYWOOD ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NE
Practice Address - Zip Code:68462-1332
Practice Address - Country:US
Practice Address - Phone:402-786-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE824235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist