Provider Demographics
NPI:1164640140
Name:WOLFE, DONALD L (MA, CCC-A, FAAA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:L
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MA, CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12211 E BROADWAY AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6132
Mailing Address - Country:US
Mailing Address - Phone:509-924-3459
Mailing Address - Fax:509-924-3459
Practice Address - Street 1:12211 E BROADWAY AVE STE 4
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6132
Practice Address - Country:US
Practice Address - Phone:509-924-3459
Practice Address - Fax:509-924-3459
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7091374Medicaid
WA98182OtherHEAR PO
WA110437OtherLABOR & INDUSTRIES
WA600497OtherPREMERA BLUE CROSS
WA98182OtherHEAR PO