Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 102L00000X | Psychologist | 105860 | IA |
N | 103T00000X | Psychologist | 105860 | IA |
N | 103TA0700X | Adult Development & Aging Psychologist | 105860 | IA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 105860 | IA |
Y | 103G00000X | Clinical Psychologist | 105860 | IA |
Y | 103TC0700X | Clinical Psychologist | 105860 | IA |
N | 103TC1900X | Counseling Psychologist | 105860 | IA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 105860 | IA |
N | 103TF0000X | Family Psychologist | 105860 | IA |
N | 103TH0100X | Health Service | 105860 | IA |
N | 103TM1800X | Intellectual & Developmental Disabilities | 105860 | IA |
N | 103TP2701X | Group Psychotherapist | 105860 | IA |
N | 103TS0200X | School Psychologist | 105860 | IA |
NPI | 1639776313 |
---|---|
Provider Name | Dr. Sara E Wise |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2020 |
Last Update Date | 09/11/2021 |