Provider Demographics
NPI:1003055138
Name:WOLTERMAN, JOELLEN MARIE (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:MARIE
Last Name:WOLTERMAN
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50311-1540
Mailing Address - Country:US
Mailing Address - Phone:505-274-1285
Mailing Address - Fax:515-274-3006
Practice Address - Street 1:6955 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50311-1540
Practice Address - Country:US
Practice Address - Phone:515-274-1285
Practice Address - Fax:515-274-3006
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA580237600000X
IA875237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter