Provider Demographics
NPI:1164042388
Name:WOLFE, KRISTINE THERESA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:THERESA
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:2720 8TH ST SW STE B
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1028
Mailing Address - Country:US
Mailing Address - Phone:515-957-3663
Mailing Address - Fax:515-957-9264
Practice Address - Street 1:2720 8TH ST SW STE B
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1028
Practice Address - Country:US
Practice Address - Phone:515-957-3663
Practice Address - Fax:515-957-9264
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002043235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist