Provider Information for 1407129422
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Dr. WANETTA H. BISE PHD, LPC, NCC, RPT
Sex: Female
NPI: 1407129422
Last Updated: 2015-11-20
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1407129422 | ||||||||
| Enumeration Date | 2012-02-22 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 309 E. ST. VRAIN STREET COLORADO SPRINGS, CO 80903-1123 United States Phone: 719-233-4020 | Fax:719-473-9203 | ||||||||
| Primary Practice Address | 309 E. ST. VRAIN STREET COLORADO SPRINGS, CO 80910-3130 United States Phone: 719-233-4020 | Fax:719-473-9203 | ||||||||
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