Provider Demographics
NPI:1063029189
Name:WOLINSKI, KACIE ANN
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:ANN
Last Name:WOLINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NW 8TH ST UNIT 108
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-8864
Mailing Address - Country:US
Mailing Address - Phone:641-740-7889
Mailing Address - Fax:
Practice Address - Street 1:1204 LINDEN ST
Practice Address - Street 2:
Practice Address - City:DALLAS CENTER
Practice Address - State:IA
Practice Address - Zip Code:50063-1052
Practice Address - Country:US
Practice Address - Phone:641-740-7889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101653235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist