Provider Demographics
NPI:1043675820
Name:WOLFE, DENISE (SLP, MA, CCC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:SLP, MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4904
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-4904
Mailing Address - Country:US
Mailing Address - Phone:308-385-5900
Mailing Address - Fax:
Practice Address - Street 1:123 S WEBB RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68802-4904
Practice Address - Country:US
Practice Address - Phone:308-385-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist